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RK656  G83  1 91 0     Greene  brothers  cli 


RECAP 


'1'^'  \r-t  T^T^  t 


Columbia  Wini\)tx^itv 

in  ttje  Citp  of  iBteto  ^orfe  \  1  \  0 

College  of  pijpgiciang  anb  burgeons 


Reference  llihvavv 


Digitized  by  tine  Internet  Arcinive 

in  2010  witii  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/greenebrotherscl1910gree 


Peter  Thomas  Greene. 
(1828-1909.) 


Jacob  Wesley  Greene. 
(1839.) 


^xatitnU  in  (lYlemortam 


To  the  memory  of  our  elder  brother  and  pre- 
ceptor, the  late 

(peter  HomciB  (Breene, 

of  New  Albany,  Indiana,  this  little  work  is  grate- 
fully dedicated. 


Dr.  P.  T.  first  recognized  the  practical  advan- 
tage of  the  shallow-tray  non-tissue-straining  prin- 
ciple in  impression-taking,  and  was  the  first  to 
introduce  it. 

He  was  an  ardent  worker  in  the  early  evolu- 
tion of  what  since  has  been  developed  into  the 
present  established  Greene  Brothers'  Advance- 
Test  System  of  Plate-  vV  ork. 

To  his  helpful,  courageous  persistency,  in  the 
face  of  ignorance,  suspicion,  jealousy,  and  envy 
(difficulties  especially  attending  old-fashioned  se- 
cret teaching),  the  new  System  owes  its  founding; 
and  progressive  plate-workers  owe,  and  will  du- 
ly bestow,  their  sincere  gratitude. 

Our  brother  began  life  near  Corydon,  Harri- 
son County,  Indiana,  in  1828,  and  departed  from 
his  earthly  home  in  New  Albany,  to  the  many 
loved  ones  of  his  youth  and  later  years,  on  the 
other  side,  in  February,  1909. 

He  served  industriously  in  his  calling,  as  a 
progressive  worker  and  instructor,  over  half  a 
century. 

Jacob  W.  Greene. 
Chillicothe,  Mo.,  July  i,  19 10. 


GREENE  BROTHERS' 

CLINICAL  COURSE 


IN 


Dental  Prosthesis 


IN 


Three  Printed  Lectures 


New  and  Advance-Test  Methods 


IN 


Impressions,  Articulation,   Occlusion,    Roofless 
Dentures,   Refits   and   Renewals 


BY 


JACOB  W.  GREENE 

Chillicothe,   Mo. 

1910 

Copyrighted  Printed   Course,  $10.00 

(All  Rights  Reserved)  Verbal,  in  Class,     25.00 

Author  of  "Dental  Information   for  the  People" — 1870.      $2.00 

Patentee  of  Greene't  Ready-Made   Metal   Models — 1908 

Inventor  of  Greene's  Removable-Handle  Impression  and   Bite  Trays — 1910 

Inventor  of  Weighted   Lower  Bite-Plates;  Tongue-Rest  Flanges  ("Jokers")  for 

Lower  Dentures;  Real  Anatomical  Bites  for  Difficult  Cases;  Greene't 

Pressometer,  for  Measuring  Stress,  in   Bites;   Short-Cut  and 

Quick-Step  Methods  in  Plate- Work 


vqio 


CORRESPONDENCE  SOLICITED 

FOR 

GREENE  BROTHERS'  VERBAL  COURSE 

•    \  TO 

STATE  MEETINGS, 
DISTRICT  MEETINGS, 
STUDY  CLUBS, 
COLLEGES  And 

CLASSES. 

Address: 

DR.  J   W.  GREENE, 

Chillicothe.  Mo. 


CONTENTS. 


LECTURE  I. 

Upper  Mouth  Only.— Reasons  for  Improved  Methods. 
— Old  Ways  Unreliable. — Test  Impressions. — Impressions 
of  All  Sorts  of  Mouths. — All  Kinds  of  Impression  Mate- 
rials— Plaster,  Modeling  Composition,  Bee's-wax,  and 
Combinations  of  Them. — All  About  Roofless  Plates,  Re- 
fits, and  Renewals  from  Old  Plates,  by  the  Greene  Test 
Methods. — Short-cut  and  Quick-step  Upper  Plates. — Un- 
reliability of  Plaster  Models  and  How  They  Cause  Fail- 
ures.— Instructions  in  Use  of  the  Greene  Non-changeable, 
Ready-made  Metal  Models  in  Vulcanizing  and  Swaging. 
— And  so  forth. 

LECTURE  II. 

Lower  Mouth  Only. — Principles  and  Methods  of  First 
Lecture,  as  Applied  to  Lower  Cases;  with  Others  Special 
to  the  Lower. — Partial  Impressions  with  Leaning  Teeth 
and  Bell-shaped  Crowns. — Why  Lower  Dentures  Are  So 
Generally  Unsatisfactory  and  How  to  Correct  the  Diffi- 
culties; by  Muscle-trimming,  Conforming,  Shot-weighting 
and  Tongue-power  Methods,  and  Consequent  Suction.— 
And  so  on. 

LECTURE  III. 

The  Bite,  and  All  that  follows,  to  the  Finished  Case, 
— Only  the  Tired-rest  Position  of  the  Jaws  Reliable. — 
The  "No-bite"  Gives  this  Position. — How  to  Take  It  and 
Test  It.— Bite  Must  Give  Four  Essential  Points— fa)  The 
Show-length  of  the  Teeth;  (b)  Their  In-and-Out  Stand- 
ing; (c)  Their  Occlusion;  and  (d)  The  Strain  on  the  Tis- 
sues.— A  Simple  Pressometer. — -Bites  for  Lower  Partials 
and  All  About  Them — Some  Old  Troublesome  Problems 
Solved. — Brand-new  Occlusion  Scheme  for  Difficult,  "Crip- 
pled" Cases — Each  Mouth  Its  Own  Anatomic  Articulator 
in  the  Finis.  —  Ethics  in  Plate-work.  —  Interesting  and 
Instructive  Lecture  to  Patient  Before  Dismissal. — And 
much  more. 


IN  Dental  Prostitksis.  ix 

CAPTIONS  AND  SUB-HEADINGS 

Indicating  Themes  and  Methods. 


LECTURE  NUMBER  ONE. 


UetEB      Dentures. 

PAGE 

Printed  Notes  for  Student's  Reference i8 

Class  Close  Around  the  Table 20 

First  Hour  of  First  Thrpe-Hour  Lesson. 21 

What  We  Want  to  Do  in  Taking  an  Impression 22 

All  Moving  Tissues  Must  Move  Air-Tight 25 

An  Approximate  Correctable  Impression 25 

Fit  Tray  to  Mouth 26 

Two  Ways  of  Fitting  Tray 26 

The  Fitted  Metal  Tray 28 

Upper  Trays  Illustrated — Old  and  New 29 

How  to  Take  Correctable  Impression 30 

Two  Ways  to  Take  Correctable  Impression 30 

Student's  Correctable  Impression 30 

Practitioner's  Approximate  Impression  (First  vStep).  .    31 

Practitioner's  Test  for  Fit 33 

Suppose  It  Doesn't  Center-Test 34 

Trim  It  Approximately  (Second  Step) 34 

To  Get  Length  of  Plate  in  a  Soft  Mouth 35 

To  Find  Length  of  Plate  over  a  Hard  Palate 36 

Correct  Roof  to  Test-Fit  (Third  Step) 38 

Correct  the  Rim  to  Muscles  (Fourth  Step) 39 

Relief -without- Leak ,  the  Modeling-Compound   Impres- 
sion Pass- Word 40 

Very-Edging,  or  Muscle-Trimming 40 

To  Especially  Fit  Particular  Muscles 42 

Conform  Compound  to  Soft  Part   (Fifth  Step) 43 


X  Greene  Brothers'  Clinicae  Course 

PAGE 

Conform  ("Post-Dam")  Back  Palate  (Sixth  Step)..  .  .    46 
The  Essential  Art  in  Handling  Modeling  Compound .  .   48 

Uniting  Details 48 

Test  the  Completed  Impression 49 

Stop,  Think,  and  Reason 50 

If  Impression  "Swallows  Down" 50 

About  Nausea 51 

Modeling-Compound  Impressions,  Old  and  New  Way 

Illustrated,  Figures  4  and  5 52 

Make  Model  on  Tested  Impression 53 

How  to  Make  the  Model 54 

To  Separate  Model  from  Impression 55 

Don't  L,et  Impression  Change 56 

Metal  vs.  Plaster  Models 56 

Greene's  Non-Changeable  Model  System 57 

Modeling-Compound  Impressions  in  Difificult  Cases.  . .    59 

Soft,  Flabby  Alveolar  Ridge  with  Hard  Roof 60 

Vienna  Paste  for  Reducing  Soft  Gums 6i 

Flabby  Gums  in  Front  and  Hard  on  Sides 63 

A  Valuable  Review 64 

Roofless  Dentures 64 

Instructions  to  Patients 66 

Extra  Supports  to  Roofless  Plates 67 

Retention  of  Roofless  Plates 67 

Partial  Upper  Impressions 68 

Leaning  Teeth  and  Bell-Shaped  Crowns 69 

Recapitulation  on  Coring 70 

Plaster  Impressions  for  Partial  Plates 70 

To  Test  a  Plaster  Impression 72 

Plaster  Impressions  in  Modeling-Compound  Trays. ...    72 

To  Take  Test-Impressions  in  Plaster 74 

Pass- Word  for  the  Greene  Method  of  Plaster  Impres- 
sions     76 

"Why  Plaster  at  All"  for  Impressions 77 

A  Quick-Step  Denture  Method. 78 

Typical  Upper  Impressions  in  Plaster — Old  and  New 

Way  Illustrated,  Figures  7  and  8 79 

Refitting  of  Plates 81 


IN  Dental  Prosthesis.  xi 

PAGE 

Temporary  Refits  with  "Perfection"  Compound  Wa- 
fers   82 

Permanent  Refit  with  Vulcanite 83 

To  Refit  with  Plaster  Impression  by  the  Pass- Word 

Method 83 

Common  Old-Fashioned  Refit  of  Rubber  Plates 87 

To  Reproduce  New  Plates  from  Old  Ones 87 

The  Greene  Ready-Made  Models  in  Refits 89 

Precaution  in  Refitting  Plates ■ 89 


xii  Gre;e;ne:  Brothers'  Clinical  Course 

CAPTIONS  AND  SUB-HEADINGS 

Indicating  Themes  and  Methods. 


LECTURE  NUMBER  TWO. 


Lower  Dentures. 

PAGE 

First:  A  Modeling-Compound  Impression  in  Detail.. .   91 

To  Avoid  Straining  the  Muscles 95 

Typical  Lower  Trays,  Old  and  New,  Figures,  10,  11,  12  97 

Take  a  Correctable  Impression 98 

Practitioner's  Correctable  Impression — Step  No.  i.. .  .  100 

Step  No.  2  in  Lower  Impression 104 

Step  No.  3  in  Lower  Impression 105 

Step  No.  4  in  Lower  Impression ■ 106 

Step  No.  5  in  Lower  Impression 107 

Step  No.  6  in  Lower  Impression 108 

Step  No.  7  in  Lower  Impression 109 

Step  No.  8  in  Lower  Impression iii 

Step  No.  9  in  Lower  Impression 112 

Step  No.  10  in  Lower  Impression 113 

A  Lower  Plaster  Impression ; 114 

Partial  Lower  Impression 115 

Modeling-Compound  Impression  with  Leaning  Teeth 

and  Bell-Shaped  Crowns 117 

Coring  Out  for  Under-Cut  Impressions .....118 

Old-Time  Improvements  in  All-Plaster  Lower  Impres- 
sions   120 

Old  Way  and  New  Way  Modeling-Compound  Impres- 
sions Illustrated,  Figures  13,  14  and  15 123 

To  Refit  a  Vulcanite  Lower  Plate  Temporarily 124 

To  Refit  a  Vulcanite  Plate  Permanently 125 

Renewal  of  Rubber  Plates  from  Old  Ones 128 


IN  Dental  Prostkt^sis.  xiii 

PAGE 

Weight  in  Lower  Dentures 130 

To  Shot- Weight  a  New  Vulcanite  Plate 131 

To  Strengthen  Lower  Plate 132 

Mixed  Lower  Plates 132 

Swaging  Lower  Plates 133 

Cast  Aluminum  Plates 134 

Refitting  Lower  ]\Ietal  Plates  with  Vulcanite 1 34 

Substitution  of  Heavy  Cast  Plates  in  Place  of  Vul- 
canite or  Celluloid 135 

To  Refit  and  Renew  a  Cast  Plate  with  the  Same  Ma- 
terial  136 


xiv  Gre;f,nh;  Brothers'  Clinical,  CoursiB 

CAPTIONS  AND  SUB-HEADINGS 

Indicating  Themes  and  Methods. 


LECTURE  NUMBER  THREE. 


page 

Articulation,  Occlusion,  Bite,  etc.,  etc 127 

Now  for  the  "Bite" .141 

Absurdity  of  a  Common  Motionary  Bite 143 

Tired  Relaxation  the  Natural  Position  of  the  Jaw. .  . .  144 

What  Do  We  Expect  from  a  Bite? 145 

The  "Biscuit,"  or  "Mush,"  or  "Squash"  Bite 145 

The  Rim  Bite 145 

The  Greene  Improved  and  Perfected  Rim  Bite 147 

Bite  for  a  Full  Upper-and-IyOwer  Set 147 

Upper  Model  First 147 

Trim  for  Fullness  of  Upper  I^ip  and  Teeth 148 

Trim  Bite-Plate  for  Length  of  Upper  Teeth 148 

Heavy  Lower  Bite-Plates 149 

Trim  Lower  Bite-Rim  for  Length  of  Lower  Teeth.  .  . .  150 

The  Outstanding  of  the  Lower  Teeth 151 

The  Tired-Rest  Test-Bite,  or  "No-Bite" 151 

Re-inspect  No-Bite  for  Feature  Test 153 

Greene  Tired-Rest  Bite  ("No-Bite")  Illustrated,  Fig- 
ure 16 153 

Fourth  Point,  or  Pressure  Feature,  in  a  Bite 154 

A  Simple,  Practical  Pressometer 154 

How  to  Use  the  Greene  Pressometer  in  a  Strain  Test.  155 

Unequal  Pressure  Sometimes  Needed  in  a  Bite 157 

Verifying  the  No-Bite 158 

Mathematical  Test  of  the  No-Bite 158 

The  Third  Still- Jaw  Test 159 

Greene  Pressometer  Illustrated,  Figure  17; 160 


IN  Dental  Prosticesis.  xv 

PAGE 

Transfer  No-Bite  to  the  Articulator i6i 

Anatomical  Movement  on  the  No-Bite i6i 

A  "Cripple"  Mouth  Its  Own  Articulator  in  the  Finis.  162 

Correct  Bites  Till  They  Do  Test 164 

Firm  Articulator  Important 164 

Articulator  in  Most  Common  Use 166 

To  Fix  Lower  Model  on  Articulator 167 

Base-Plates 168 

The  Dip  Method  of  Making  Base-Plates 169 

Setting  Up  Teeth  on  Base-Plate 169 

Trying  Teeth  in  the  Mouth 171 

Side  Remarks — Prosthetic  Quackery 172 

Wax  Up  the  Upper  Case 173 

Set  Up  the  Lower  Teeth 174 

"  Watch- Word  "  in  Setting  up  Teeth 1 75 

Wax  Up  Lower  Set 175 

The  Important  Tongue-Rest  Scallop 176 

The  Final  "Joker"  in  Lower  Cases 177 

Another  Reason  for  the  Joker 178 

The  Joker  a  New  Idea 179 

The  Lateral,  or  "Sheep-Bite,"  Movement 180 

The  Common  Old  Plain- Line  Articulator  Improved  for 

Anatomic  Work 181 

The  Forward  Bite  Movement 183 

Each  Mouth  Its  Own  Articulator  in  the  Finis  Fur- 
ther Described 184 

Class  Requests  Difficult  "Cripple "-Case  Articulation 

Again  and  Further  Explained 184 

New  Way  to  Take  Test  No-Bite,  in  No-Handle  Bite- 
Trays 187 

Improvement  in  Biscuit  Bites 188 

Flasking  the  Case 189 

Packing  and  Vulcanizing 190 

How  to  Vulcanize 191 

Dishonesty  in  Rubber  Plates 192 

Last  Finishing  Care  in  Articulation 194 

A  Still  Finer  Last  Grinding  Touch 195 

Better  Defer  Final  Adjustment 196 


xvi  G-REKnp:  Brothers'  Clinical  Course 

PAGE 

Instructions  to  Wearer  of  Artificial  Teeth 199 

No-Bite  of  a  Plain  Upper  Case 196 

The  Non-Lateral,   Minimum  Short-Bite,  or  No-Bite, 

Described  Again,  by  Request 201 

The  Full  Upper  No-Bite  Test 202 

Transfer  the  No-Bite  to  Articulator 203 

Pink  Rubber  and  Gum  Sections 204 

Pressometer  in  Upper  Cases 205 

Partial  Posterior  Lower  Bite 205 

[See  Index,  Page  210.] 


GREENE    BROTHERS'  CLINIC  LECTURE 
COURSE  IN  PLATE=WORK. 


Why  in  Print. 

While  this  Course  is  limited  to  plate=work, 
it  embraces  most  of  the  important  points  in 
that  specialty;  and  on  lines  of  original,  new 
and  improved  methods.  Also  it  is  more  par- 
ticularly meant  for  vulcanite  and  similar  work; 
.of  which  probably  90  per  cent,  of  all  plates  are 
now  made. 

It  is  given  as  a  private  course  of  instruc- 
tion for  practical  utility,  and  more  especially 
for  active  practitioners. 

No  "honors''  are  offered,  save  that  for  im- 
provement in  this  most  difficult  and  uncertain 
branch  of  dentistry. 

Yet  in  self=defense,  against  deception  and 
fraudulent  pretensions,  we  give  our  certificate 
to  show  one  has  taken  our  Course  directly  from 
central  authority. 

Though  we  have  been  instructing  more  or 
less  from  the  incipiency  of  the  work  fifteen 
years  ago,  when  we  gave  but  an  hour  (then 
mostly  on  impressions),  up  through  its  devel- 
opment to  an  eight=  to  ten=hour  Course,  we  have, 
not  been  giving  it  publicly  till  1907. 

So  there  are  yet  but  a  few  schools  that  have 
it  familiar  enough  to  enable  its  thorough  teach- 
ing to  inexperienced  students.  From  now  on 
we  expect  to  give  it  to  all  willing  to  pay  reas- 
onably for  our  service. 

As  justification  for  charging  for  our  time,  it 
is  necessary  only  to  mention  that  we  have  en- 
tirely given  up  our  private  practice  to  devote 


10  Grkkne;  Ijrothhrs'  Clinical  Course 

our  aged  efforts  to  the  new  Private  Insiniction 
Business  for  a  livelihood. 

About  teaching  it:  After  many  years'  exper- 
imentation and  gradual  development,  our  prac- 
tical Course  now  embraces  a  System,  including 
some  advance  test  methods,  where  the  work  is 
exact  and  technical.  Hence,  the  imparting  of 
it  to  others  is  not  a  little  matter  to  be  "  told ' ' 
on  the  side=walk;  nor  even  well  taught  at  a 
distance,  in  hurried,  public  clinics,  by  an  in- 
experienced novice. 

To  our  amusement,  dentists  sometimes  tell 
us  they  "already  know"  our  methods  because 
someone  has  "told"  them  what  they  are.  The 
fact  is:  to  perfectly  teach  the  Greene  System 
(or  any  other)  one  must  fully  understand  its 
basic  principles,  have  expert  experience,  and  be 
familiar  with  practical  teaching  requirements. 

To  this  end  our  business  plan  has  been  to 
instmct  individuals,  classes,  and  local  societies, 
in  limited  numbers,  in  their  towns  and  cities; 
usually  by  pre-arrangement. 

When  wanted,  we  go  also  to  colleges  and 
instruct  classes  of  advanced  students,  in  groups 
of  ten  or  less. 

At  no  distant  time  we  hope  to  see  many  of 
the  plate=work  instructors  in  the  schools  famil- 
iar enough  to  themselves  fully  teach  their  stu- 
dents in  the  new  ways.  The  trouble  is  that 
so  many  schools  employ  inexperienced  men  and 
boy  instructors  on  glory=pay  in  this  important 
branch  of  dentistry. 

The  need  of  our  Course  is  fitly  emphasized 
when  eminent  prosthesists  publicly  assert  that 
"Good,  artistic  plate=work  is  fast  becoming  a 
lost  art." 

Years  ago,  even  up  into  the  '80s,  a  goodly 
share  of  most  dentists'  practice  consisted  of 
plate=work.     There   was   so   much   of   it   done, 


IN  Dental  Prosthesis.  II 

and  so  comparative!}"  few  dentists  to  do  it, 
that  many  became  experts,  even  in  the  old 
guess=work  methods. 

So  the  average  grade  of  the  out=put  was  de- 
cidedly above  that  of  no w=a=  times;  now,  when 
most  of  the  old  "mechanical  dentists "  are  gone, 
and  the  young  men  disdain  the  "dirty,  uncer- 
tain work." 

And  so  it  is  that  the  once  attractive,  art- 
istic specialty  has  been  discarded  by  both  the 
boys  and  the  "best  men"  and  turned  over  to 
commercial  (mal) practice.  And  such  practice 
obtains  to  the  extent  that  half  the  plate= wear- 
ers look  like  silly  and  vicious  ghosts  grinning 
through  moonshine. 

It  was  the  prideful  effort  of  the  old=timers 
to  rather  hide  art  and  imitate  Nature.  So,  in 
the  more  professional  (we  called  it  "mechan- 
ical") past,  dentists  far  more  seldom  allowed 
patients  to  dictate,  and  "pick  out  teeth  to  suit 
themselves";  which  they  are  wont  to  do  with 
unquestioned  commercial  license. 

Sure  enough  the  old=timers  have  reason  to 
conclude  that  "artistic  plate=work  is  fast  be- 
coming a  lost  art."  Much  of  it  is  being  done 
in  "false=tooth  factories"  b}^  boys  who  have 
never  studied  dentistry  at  all,  and  who  never 
get  to  see  the  disfigured  faces  through  which 
their  glossy  =  white  pearls  must  grin  =  shine  so 
hideously. 

How  many  dentists  (commercial  proprietors) 
boastfully  tell  us:  "/  don't  do  plate=work  mv- 
self.  /  simply  take  the  impressions  and  bites 
and  have  the  main  work  done."  What  a  pro- 
fessional conception! 

Two  gobs  of  material — impression  and  bite — 
hurriedly  thrust  into  the  mouth  and  jerked  out ; 
then  turned  over  to  the  laboratory  boys  and 
girls,  strangers  in  the  case — "sight  unseen"! 


12  Grrkne  Brothers'  Clinical  Course 

The  "toc=busy  "  dentist  (and  there  are  many 
of  them),  who  can  neither  do  his  own  plate= 
work  personally  nor  have  it  done  under  his  own 
supervision,  giving  due  study  to  each  case  on 
its  own  peculiar  merits,  should  turn  it  over  to 
the  legitimate  specialist,  who  can  handle  such 
important  practice  consistently  and  properly. 

It  is  one  of  the  purposes  of  the  Greene 
Brothers'  Course  to  encourage  and  train  special- 
ists to  care  for  this  most  difficult  work  of  the 
dental  art=  science. 

For  years  we  have  been  urged  to  give  our 
lecture  =  demonstrations  in  printed  form,  and 
teach  our  methods  in  that  more  convenient  and 
less  expensive  way.  But  for  several  reasons 
we  have  refrained  from  doing  so  till  now. 

We  have  feared  the  difficult}^  of  teaching 
fire  points  in  art  by  mail.  We  feared  failures 
might  bring  our  System  into  disrepute  before 
fully  established,  and  ruin  at  least  our  business. 

But  now  we  feel  differently.  After  a  mid= 
teen  3^ears  of  persistent  work,  and  since  we  have 
reached  national  attention  by  publicly  lectur- 
ing and  demonstrating  to  local  and  State  and 
National  meetings,  with  fully  satisfactory  re- 
ception, we  are  persuaded  to  yield. 

Since  we  have  the  backing  of  thousands  of 
testimonials  of  satisfaction  and  earnest  recom- 
mendations from  our  student  practitioners  of 
all  classes  and  grades  in  half  of  the  States  in 
the  Union,  we  no  longer  fear  that  a  few  pos- 
sible failures  to  understand,  or  a  few  technical 
criticisms,  or  even  kickers,  would  seriously  harm 
our  "traveling  dental  school." 

Then,  as  there  is  but  one  of  us  left  and  as 
he  is  doing  business  on  borrowed  time  (this 
1910),  we  have  consented  to  this  publication. 

In  so  doing  we  have  first  in  mind  those  who 
have  taken,  or  ma}^  take,  our  Course  from  us 


IN  Dental  Prosthesis.  13 

in  our  regular  way,  but  who  may  not  have 
caught  onto,  or  may  not  catch  onto,  all  of  our 
numerous  new  pointers;  also  those  who  inay 
have  forgotten,  or  may  forget,  some  of  them 
before  opportunity  for  practice. 

To  such  the  printed  Course  can't  fail  to  prove 
a  most  valuable  reference;  even  though  in  it 
we  have  abridged  many  of  our  verbal  repeti- 
tions and  cut  out  some  of  our  odd  but  con- 
vincing illustrations,  used  in  the  lecture=work. 

Second,  we  have  in  mind  the  thousands  who 
will  have  their  attention  called  to  our  work, 
but  could  never  get  it  from  the  central  source 
in  any  other  way  than  this. 

I  may  add  that,  though  a  student  of  our 
methods  through  these  printed  lectures  will  un- 
fortunately miss  the  inspiration  of  personality 
that  always  goes  with  all  verbal  teaching  (and 
to  which,  maybe,  too  much  is  sometimes  ac- 
credited in  our  class= talks) ,  he  will  neverthe- 
less get  our  most  important  inventions,  discov- 
eries and  new  practical  pointers,  if  he  will  think. 

We  have  tried  to  be  clear  and  comprehen- 
sive, and  hence,  in  some  sense,  to  some  readers, 
may  be  uselessly  detailing. 

To  steer  clear  of  literary  pretense,  when  I 
know  I  'm  not  "in  it,"  I  have  herein  held  much 
to  the  colloquial  and  self=idiomatic  of  my  verbal 
Course. 

Having  scratched  all  this  out  from  steno- 
graphic notes,  taken  from  my  offhand  talks  in 
class=work,  I  may  have  edited  carelessly,  if  not 
ignorantly,  as  to  elegance  of  diction.  With  my 
sole  aim  to  eliminate  some  of  the  guess=work 
and  uncertainty  from  "mechanical  dentistry" 
and  to  help  restore  the  "lost  art,"  I  may  have 
thought  (maybe  known)  less  of  rhetoric  than 
of  work. 

Maybe  I  should  apologize  for  even  worse — 


14  Greene  Brothers'  Ceinicae  Course 

for  coining  some  non=dictionarial  vocabulary. 
Well,  that  's  been  done  before;  otherwise  we  'd 
have  no  "occlusion,"  nor  "articulation,"  ap- 
plicable to  artificial  teeth.  Pardon  my  inde- 
pendence. 

If,  with  all  my  acknowledged  shortcomings, 
I  have'  been  helpful,  in  a  measure,  to  the  work- 
ing dentists  and  to  the  wearers  of  artificial  teeth, 
my  purpose  has  been  attained  and  my  chronic 
ambition  gratified. 

Jacob  W.  Greene. 


IN  Dental  Prosthesis.  15 


CRITICS,  DON'T! 

"0/z,  that  mine  eneiny  woiild  write  a  book!'' 

Don't  imagine  this  a  text=book,  please.  It  's 
merely  a  series  of  offhand,  "show=me"  talks 
in  print;  by  an  old=and=childish  "tooth=dent- 
ist"— three=score=and=ten,  and  then  some. 

Don't  tantalize  while  I  weep  for  its  literary 
weakness!  It  was:  Write  this,  or  keep  on  talk- 
ing— three  to  six  hours  a  day.     I  'm  tired. 

Don't  criticise  my  repetition.  I  've  learned 
that  most  dentists  need  the  like  in  their  studies. 

Don't  object  to  this  mail  Course.  My  itin- 
erant dental  school  is  getting  too  old  to  trek. 

Don't  wink=smile  at  my  impromptu  vocab- 
ulary. It  's  the  answer  to  my  prayers  for  in- 
spiration, meet  for  the  occasion. 

Don't  accuse  me  of  competition  with  (pother) 
dental  colleges.  I  'm  only  setting  up  and  fin- 
ishing their  goods,  .shipped  out  in  the  knock= 
down. 

Don't  blame  me  for  not  having  my  sub- 
themes  and  pointers  in  more  systematic  order. 
I  was  incarnated  in  Old  Hoosier,  in  the  early 
days,  in  the  woods,  among  the  whoo=owls,  on 
Friday  night,  in  the  dark  of  the  moon,  out  of 
order,  against  my  better  judgment. 

Don't  accuse  me  of  egotism.  I  'm  unas- 
suming. I  'm  patient.  I  can  listen  by  the  hour 
to  dentists  repeating  how  they  do  things  (by 
the  old  guess=ways). 

Don't,  above  all,  criticise  because  yon  can't 
understand  me.  "The  carnal  (dento  =  carnal) 
mind  can  not  discern  spiritual  (dento=spiritual) 
things." 

J.  W.  G. 


16  Grekne  Brothi^rs'  Clinical  Course 


INTRODUCTORY. 

While  the  Greene  Brothers'  Prosthetic 
Course  is  hmited  to  plate=work,  it  takes  in  about 
all  of  that  niuch=neglecteci  branch;  and  along 
new  lines  and  advance  test  methods. 

By  test  methods  we  mean  such  as  enable  us 
to  know  by  actual  test  in  advance  what  the 
resultant  outcome  will  be. 

To  illustrate  my  meaning  I  will  stippose  you 
have,  for  instance,  a  plate  that  exactly  suits 
you  and  its  wearer.  If  you  should  mold  and 
duplicate  another  one  from  it,  you  would  know, 
in  advance,  just  how  the  new  one  would  be. 
Bear  in  mind,  I  say,  if  you  duplicate  the  tested 
plate. 

Now,  it  is  proposed  to  give  you  a  whole 
course,  amounting  to  a  System,  of  advance=test 
plate=work  methods,  covering  about  all  of  the 
important  points  in  the  specialty. 

THREE  SEPARATE  LECTURES. 

The  Course  is  generally  given  in  three  sep- 
arate clinic  lecture=demorstrations,  wherein  the 
principles  are  taught  by  reason  and  analogy,  and 
the  application  by  "showing"  (from  Missouri). 

Incidentall}^  it  becomes  necessary  to  show, 
likewise  by  reason  and  application,  that  some, 
and  not  a  few,  of  the  old  and  commonly  used 
methods  are  not  only  defective  and  faulty,  but 
absolutely  erroneous  and  absurd. 

Sometimes  it  becomes  necessary  to  show  the 
defection  of  an  old  road  bridge,  and  to  remove 
it  before  substituting  a  better  one  in  its  place. 
And  again  sometimes  it  's  best  to  remove  the 
old  structure  by  section  and  piece  and  substi- 


IN  Dental  Prosthests.  17 

tute  corresponding  parts  of  the  new  one,  work- 
ing the  old  and  new  in  together,  into  one  re- 
construction. 

Our  System  a  General 
Reconstruction. 

In  a  comprehensive  sense  the  Greene  Broth- 
ers' System  is  a  reconstruction  of  plate=work 
methods. 

If  in  plate = work  the  impressions  and  models 
and  "bites"  and  the  like  can  be  compared  to 
the  abutments  and  pillars  and  arches  of  a  rail- 
road bridge,  our  methods  may  be  taken  as  a 
somew^hat  radical  departure  reconstiiiction. 

I  hope  to  make  these  truths  appear  plain 
as  I  proceed  s}'stematically  in  my  analogies  and 
practical  demonstrations. 


IS  Greene  Brothers'  Cunicae  Course 


THE  FIRST  SECTION,  OR  "DEGREE." 

The  first  one  of  the  three  sections  of  our 
Course,  here  to  be  considered,  pertains  to  the 
upper  mouth  only.  And  here  I  '11  mention,  as 
an  indicating  prelude,  the  leading  subjects  to 
be  dealt  with  in  this  lesson;  the  minor  ones  to 
come  in  at  opportune  times  and  places,  as  we 
proceed. 

First — Test  Impression;  full  and  partial; 
in  all  types  of  cases,  easy  and  difficult  ones; 
with  all  the  different  sorts  of  materials  in  com- 
mon use,  as  modeling  composition,  plaster,  bee's= 
wax,  and  combinations  of  them. 

Second — The  whole  matter  of  roofless  dent- 
ures, in  clear  mouths  and  also  over  "anchors" 
(wom=off  teeth) ;  and  partial  cases. 

Third — Test=methods  of  refitting  plates,  both 
temporarily  or  permanently;  and  renewing,  or 
duplicating,  new  ones  from  old  ones,  still  main- 
taining occlusion  and  position  of  teeth,  or  chang- 
ing the  same  if  desired. 

Fourth— Jhe  making  of  dentures  by  short= 
cut,  quick  methods,  whereb}^  a  fast  worker  can 
make  a  perfectly  fitting  {pre=tested)  plate  of  vul- 
canite or  celluloid  in  from  two=and=a=half  to 
three  hours,  from  start  to  finish. 

These  and  more  are  included  in  our  first  sec- 
tion, or  "degree,"  of  the  three  of  our  Course. 

However,  in  case  of  large  classes  we  some- 
times divide  these  sections  so  as  to  give  the 
full  Course  in  four  or  more  lessons,  as  may  mu- 
tually suit  our  time  and  convenience. 

Printed  Notes  for  Students. 

We  have  here  printed  notes  on  the  leading 
and  more  important  points;  one  list  of  them 
for  each  of  the  three  sections,  or  lectures. 


IN  Dental  Prosthesis.  19 

Each  individual  of  the  class  is  entitled  to 
these  slips,  which  notes  will  be  explained  by 
me,  in  detail,  in  the  clinic,  and  then  read  aloud 
immediately  following  by  someone  of  the  class. 

The  demonstration  and  the  reading  together 
will  impress  the  points  on  your  minds,  and  the 
preserved  notes  will  be  your  references  in  the 
future,  if  necessary.* 

After  the  reading  of  each  note  any  member 
of  the  class  can  ask  for  any  further  explanation 
he  desires  on  the  points  gone  over.  But  we  '11 
have  no  time  to  listen  to  criticisms,  discussions, 
nor  to  how  you,  or  others,  do  these  things,  until 
the  lecture  is  over. 

But  I  do  want  you  to  ask  pertinent  ques- 
tions, and  even  ask  for  repetitions  until  you 
ftilly  understand  each  point;  then  you  '11  prob- 
ably have  no  criticisms  to  offer. 

Should  you  ask  questions  out  of  time  and 
place,  which  eagerly  interested  students  are  apt 
to  do,  I  will  then  inform  you  that  the  answer 
will  come  in  later,  in  its  order. 

At  the  close  of  each  lecture  we  '11  review, 
if  desired;  and  then  again  at  the  close  of  the 
Course.  I  am  no  less  desirous  that  you  ftilly 
catch=on  than  3^ou  yourselves  are;  for  I  live 
wholly  by  what  my  students  say  of  me  and  of 
miy  work. 

As  an  incentive  to  m'y  effort  to  please  and 
to  benefit  I  expect  to  earn,  and  seldom  ever 
fail  to  get,  the  best  recommendation  mv  stu- 
dents can  write.  (And  I  '11  mention  by  way 
of  parenthesis  I  have  over  a  thousand  such  tes- 
timonials, on  their  own  letter= heads,  that  I 
"point  to  with  pride."  Scores  of  these,  as  some 
of  you  have  seen,  are  from  the  "best  men"  of 
highest  national  standing.) 

*This  printed  work  will  now  supplant  the  note  references. 


20  Greene  Brothers'  Clinical  Course 


LECTURE  NUMBER  ONE. 


(Class  close  around  the  table.) 

Doctors:  You  will  now  all  come  up  close 
enough  to  the  clinic  table  to  not  only  hear  my 
whys,  but  see  what  I  do,  and  distinctly  how  I 
do  things.  For  some  of  the  points  I  will  make 
are  as  "fine"  as  anything  you  do  at  your  op- 
erating= chair,  or  with  your  blow=pipe.  And 
some  things  here  must  be  done  almost  as  quick- 
ly as  a  snap=shot  negative  is  taken. 

But  now  don't  get  scared  at  this  statement, 
for  I  'm  not  going  to  require  of  you  anything 
more  difficult,  or  more  particular,  than  many 
things  you  do  in  almost  every  other  operation 
you  perform.  But  I  shall  require  of  you  the 
same  pains  and  exactness  of  manipulation  in 
plate=work  that  you  exercise,  for  nicety  and 
success,  in  other  branches. 

The  patient  who  pays  your  fee  for  a  set  of 
teeth  is  just  as  much  entitled  to  the  best  you 
can  do  as  the  one  who  pays  you  for  a  fine 
crown,  bridge  or  filling.  (Pardon  my  digres- 
sion off  into  professional  ethics — you  are  my 
patients  for  the  time.)  Before  we  get  through 
the  Course,  you  '11  concede  I  owe  no  apology 
for  these  last  suggestive  remarks. 

A  Class  Student  as  Patient. 

I  will  now  need  one  of  you  with  a  liberal 
mouth  and  no  mustache,  at  my  left  side,  whom 
I  '11  honor  as  "Madam." 

Now,  Madam,  I  want  you  to  see  me  wash 
my  hands  and  scrub  my  nails  with  clean  water, 
soap  and  a  brush,  before  they  go  into  your 
mouth.  As  a  nice  madam,  of  course,  you  have 
no  disagreeable  oral  habit! 


IN  Dental  Prosthesis.  21 

Now,  Madam  Jones,  while  you  will  be  my 
main  patient,  I  '11  have  an  eye  single,  and  a 
different  finger,  for  the  mouths  of  the  rest  of 
the  class,  opportunely.  (A  spontaneous  labi= 
lingtia  crusade  against  the  "weed"  all  around.) 
You  can  all  best  realize  these  touches  first 
■  in  your  own  mouths;  later  on,  for  practice,  in 
the  hospitable  mouths  of  your  mothers=in=laM^ 

First  Hour  of  First  Lesson. 

I  will  mention  here  that  the  first  hour  of 
this  three=hour  lesson  is  spent  in  the  general 
manipulation  and  improved  methods  of  hand- 
ling and  working  modeling  composition,  in  tak- 
ing impression;  first  in  full  cases,  and  then  in 
partial  ones — easy  and  difficult  ones  included. 

Strange  and  unreasonable  as  it  may  seem, 
the  very  inventors  of  modeling  impression  ma- 
terial don't  conceive  of  its  real  possibilities; 
hence,  I  may  add,  only  a  few  produce  an  article 
with  needed  possibilities. 

Usually  it  is  condemned  by  the  ' '  best  men ' ' ; 
and  well  it  may  be,  as  a  whole,  if  worked  by  the 
old  methods  in  common  practice.  Nine=tenths 
of  all  "brands"  are  faulty,  even  by  the  im- 
proved methods;  and  all  of  them  practically 
worthless  by  the  old  ways,  and  in  the  common 
spread=mouth  trays — excepting  in  simple  and 
easy  cases. 

But  with  the  right  materials,  used  in  the 
right  handling,  composition  material  is  not  only 
the  best  material,  but  about  all  that  could  be 
desired.  If  this  sounds  "fishy,"  just  wait  and 
see! 

With  it  we  can  take  an  approximate  or  * '  cor- 
rectable" impression,  and  adapt  and  conform 
it  in  detail  to  the  different  tissues  and  muscles 
of  the  mouth,  both  stationary  and  movable,  un- 
til each  place  is  fitted  and  tested  to  a  certainty 
of  correctness. 


22  Grecnj;  Brothers'  Clinical  Course 

And  then  as  a  finished,  completed  result  we 
can  absolutely  test  as  to  its  fit  as  a  whole  under 
the  practical  movements  of  the  mouth  gener- 
ally; and  then  easily  duplicate  a  denture  from 
it  that  must  stand  the  movements  the  tested 
impression  stood. 

That  is  to  say:  if  in  a  modeling=compound 
impression  we  find  that  any  muscular  move- 
ment will  throw  it  down,  or  up,  we  can  change 
and  correct  it  when  we  know  how. 

Really,  however,  it  makes  little  difference 
of  what  material  an  impression  is  made,  just 
so  it  stands  the  test  of  the  movements.  The 
practical  question  is:  What  material  can  be 
made  to  conform  to  the  moving  muscles,  giv- 
ing them  room  to  move  in  freely,  and  yet  press 
with  valve=like  tightness,  giving  relief  without 
leak? 

These  are  the  essential  qualities  of  any  ma- 
terial for  test  impressions;    we  trust  no  others. 

Now,  it  is  for  me  to  show  you  what  should 
be  done,  how  to  do  it,  and  what  to  do  it  with. 

What  We  Want  to  Do  in  Taking  an 
Impression. 

In  taking  an  impression,  the  main  three 
points  to  be  attained  are:  (a)  the  correct  height 
and  length  of  the  expectant  plate;  (b)  about  an 
equal  strain  on  the  stationary  hard  and  the  soft 
parts  of  the  covered  mouth,  at  about  the  pres- 
sure it  is  to  be  worn;  then  (c)  room  for  the 
movable  parts  to  move  in  and  still  be  valve= 
like  tight.  That  is  to  say,  again,  relief = without = 
leak  in  muscular  motion. 

If  taken  at  a  much  harder  pressure  than 
the  plate  is  to  be  worn,  the  tissues  will  be  dis- 
torted, and,  of  course,  the  plate  will  not  fit 
when  the  parts  are  not  strained,  but  must  come 
back  to  their  normal  position.     It  looks  like 


IN  Dental  Prosthesis.  23 

everybody  ought  to  think  of  this,  but  only  a 
few  do. 

Let  me  close  m}'  left  hand  and  call  the  back 
part  of  it,  including  my  knuckles,  a  mouth, 
with  hard  and  soft  parts.  The  knuckles  are 
the  hard  parts  and  between  the  knuckles  the 
soft  parts. 

Now,  contrary  to  the  general  teaching,  you 
always  get  the  impression  of  the  hard,  station- 
ary parts  right.  No  matter  what  material  you 
use  or  pressure  you  give,  3^ou  get  the  impres- 
sion of  the  hard  parts  about  right — right  in 
proportion  to  their  solidity. 

You  think  your  plates  rest  too  hard  on  the 
hard  parts,  and  are  told  to  scrape  them  there 
and  ' '  relieve ' '  them.  A hsurd,  for  they  are  right, 
in  proportion  to  the  hardness  under  them. 

If  anything  is  wrong,  it  is  on  the  soft  parts, 
or  else  the  movable  hard  parts ;  which  exception 
we  11  consider  in  a  few  minutes. 

See  me  press  with  my  right  index  finger  be- 
tween the  knuckles  on  my  left  fist.  The  tissue 
is  soft  and  it  yields.  Just  so  do  the  soft  parts 
in  the  mouth  give  when  you  take  an  impression, 
with  either  modeling  compound  or  thick  plas- 
ter. But  the  knuckles  don't  A^eld — excepting 
that  of  the  left  little  finger. 

Now  for  the  impression,  supposing  it  to  be 
of  my  hand.  To  get  it  correct  we  must  make 
this  soft  tissue  yield  just  enough  to  give  us  a 
pressure  equal  with  that  on  the  knuckles,  at 
about  the  strain  the  denture  is  to  be  worn. 

If  we  press  too  hard  on  the  soft  parts  and 
strain  them  too  much,  the}''  will  rebound  when 
we  cease  the  pressure,  and  will  lift  the  impres- 
sion (or  plate)  off  the  hard  parts;  in  which  case 
there  would  be  air  under  it,  over  the  hard  parts. 
And,  of  course,  the  air  there  would,  to  some 
e"xtent,   offset  and  neutralize  the  air  pressure 


24  Grekne;  "Brothers'  Cunical  CoaRSE 

from  the  opposite  (upper)  s^de.  In  other  words, 
our  "suction"  (atmospheric  weight)  would  be 
lessened. 

But,  on  the  other  hand,  if  we  press  too  light- 
ly on  the  soft  parts  and  don't  make  them  give 
any  at  all,  the  impression  (or  plate)  will  rest 
so  loosely  on  them  as  to  admit  of  air  there;  and 
again  we  'd  have  lessened  atmospheric  pressure. 

Atmospheric  pressure  and  ^ '  suction  "  are  syn- 
onymous terms.  Whenever  there  is  any  air  un- 
der a  plate,  however  rarefied  it  may  be,  the 
"sticktion"  will  be  lessened  accordingly. 

So,  when  you  don't  press  the  soft  parts  up 
with  enough  strain,  you  say  your  plate  rests 
too  hard  on  the  hard  places.  This  isn't  ex- 
acth^  true — only  relatively  true,  since  the  bear- 
ing is  correct  on  the  hard  parts,  and  lacking 
elsewhere. 

' '  Perfect  adaptation ' '  means  a  similar  strain 
on  the  hard  and  soft  places;  but  atmospheric 
pressure,  or  "suction,"  is  what  holds  an  upper 
plate  to  its  place — unless  clasps  or  other  clap= 
trap  means  are  used. 

I  '11  merely  remark  here,  a  little  premature- 
ly, that  I  '11  show  you  later  on  in  this  lesson 
that  it  takes  surprisingly  little  "suction"  to 
hold  a  plate  up  if  it  has  no  strain  to  throw 
it  loose. 

But  equalized  strain  on  the  hard  and  soft 
parts  isn't  all,  nor  even  the  most  important 
thing,  to  be  obtained  in  this  matter.  We  have 
movable  parts — muscles  and  tissues — that  must 
be  accommodated,  as  you  here  see  on  and  around 
my  little  finger's  moving  knuckle,  as  I  tighten 
and  loosen  my  hand's  grip. 

Now,  in  a  plate,  and  consequently  in  our 
impression,  we  must  provide  for  this  movement; 
or  it  will  lift  it  up,  if  a  lower  one,  or  work  it 
loose,  if  an  upper  one. 


IN  Dental  Prosthesis.  25 

This  is  usually  done,  or  rather  attempted  to 
be  done,  by  scraping  the  plate  after  it  is  made; 
or  by  trimming  the  impression  with  a  knife — 
both  by  guess. 

The  moving  muscle,  or  other  moving  part, 
must  not  only  have  room  to  move  in,  but  it 
must  move,  as  we  say,  valve=tight,  air=tight. 
Otherwise  air  will  get  under  it,  and  away  goes 
your  "suction,"  ^^our  atmospheric  hold. 

All  Moving  Tissues  Must  Move 

AlR=TlGHT. 

Now,  doctors,  get  3'ourselves  full  a?-  impressed 
with  this  essential  fact  in  plate=work.  But  who 
can  file  and  scrape  impressions,  models,  and 
plates,  so  a  muscle  can  work  freely  and  yet  be 
air=tight?  Or,  as  we  say,  valve=tight,  similar 
to  a  piston  in  a  tube  syringe  ? 

"  Guess=work  is  as  good  as  any  when  it  hits." 
But  how  man 3^  can  guess  out,  or  guess  off,  room 
for  a  straining  muscle  to  move  with  valve=tight 
pressure?  Only  the  experienced  few,  and  then 
only  in  easy  cases. 

We  have  a  way  of  making  this  air=tight 
working  room  without  file  or  scraper;  and,  too, 
without  guessing. 

Ihis  is  done  by  a  method  of  muscle=trim- 
ming,  soon  now  to  be  demonstrated,  in  this 
lesson . 

An  Approximate,  Correctable 
Impression. 

We  first  take  an  approximate,  "cori'ectable  " 
impression;  which  is  but  a  modeling= compound 
tray  within  a  metallic  tray.  By  "correctable" 
I  mean  one  that  has  none  of  the  metal  tray 
in  sight. 

Then  we  transform  this  correctable  impres- 
sion, or  tra}^  into  an  accurately  fitting  test  im- 
pression;   at  some  detail  when  necessary. 


26  Greene  Brothers'  Clinical  Course 

Fit  Metal  Tray  to  the  Mouth. 

To  avoid  straining  the  tissues  and  distort- 
ing the  mouth  to  be  covered,  we  use  only  shal- 
low, or  low=rininied,  metal  trays — never  deep 
ones. 

These  trays  are  always  lower  on  rim  and 
shorter  in  length  than  our  finished  plate  is  to 
be ;  and  never  steep  in  the  roof,  lest  we  strain 
the  back  palate  with  metal  and  then  lack  ma- 
terial for  correcting  the  strain. 

Our  metal  trays  are  low,  also,  m  order  that 
we  may  not  strain  the  lip=and=cheek  tissues; 
and  further  that  we  may  have  material  above 
the  rim  which  can  be  reduced  or  extended  in 
transforming  the  modeling  =  composition  tray 
into  an  impression. 

Should  you  ever  need  a  deeper  metal  tray 
(very  seldom),  you  can  trace=on  an  edge  of  mod- 
eling compound  from  a  round  stick  of  the  same 
material  as  the  impression,  heated  over  a  spirit 
lamp — here  shown. 

This  traced=on  rim  is  hard  when  you  want 
it  hard  and  will  be  soft  when  so  needed.  For- 
merly I  used  common  sealing=wax  to  build  up 
the  edges  of  my  metal  trays;  but  these  (Kerr's 
"Perfection"*)  sticks  are  better,  from  the  fact 
that  these  rims  become  a  part  of  the  finished 
impression. 

Two  Ways  to  Fit  Tray. 

For  this  we  have  two  methods:  the  student's 
method  and  the  practitioner's  method.  I  '11 
first  give  you  the  student's  way.  It  is  to  first 
take  a  common,  hurried  impression  "any  old 
way,"  and  make  a  hurried  model  from  it;  and 
then  fit  a  tray  to  this  approximate  model,  in- 


*I  know  of  no  other   that  will   trace  so  well  as   this  Kerr's 
'Perfection." 


IN  Dental  Prosthesis.  27 

stead  of  fitting  it  to  the  mouth  itself;  the  lat- 
ter being  the  practitioner's  method. 

The  student's'method  is,  in  fact,  a  good  one 
for  even  the  most  experienced,  who  are  willing 
to  take  a  little  extra  time  to  first  get  this  ap- 
proximate model.  Indeed,  it  is  the  preferable 
way,  and  becomes  the  settled  one  with  many 
of  my  students  in  practice. 

Well,  I  have  a  model  here  before  me.  We  '11 
suppose  it  to  have  been  made  by  some  one  of 
3^ou  from  a  hurried  common  impression — or,  as 
for  that,  from  a  "good"  impression  ("good," 
but  untested  and  not  known  to  be  good). 

We  '11  take  an  old  soft=metal  tray  and  cut 
it  off  at  the  heel  so  as  to  be  a  little  shorter 
than  we  think  our  coming  plate  should  be;  and 
then  we  '11  trim  it  down  at  the  sides  and  in 
•front,  so  as  not  to  be  quite  as  high -as  we  think 
our  plate  should  be. 

We  '11  thus  make  it  seemingly  about  a  full 
one=eighth  of  an  inch  too  short  and  too  shallow 
all  around.  And  we  '11  flatten  it  down  so  as  to 
have  very  little  elevation  in  the  center.  If  we 
get  its  rim  an  eighth  of  an  inch  realh^  too  low, 
no  harm  done;  for  our  impression  material  will 
become  a  rim  of  itself. 

Then  we  want  the  metal  tra}-^  a  little  larger 
than  our  model  (or  mouth) ,  so  as  to  work  loose- 
ly over  it;  say  with  a  scant  eighth  of  an  inch 
play  all  around  it. 

It  is  easier,  at  least  for  a  novice,  to  fit  a 
metal  tray  to  a  model  than  to  a  mouth.  Ex- 
perienced practitioners  can  readily  fit  it  to  the 
latter.  But  whichever  way  you  do  it,  fit  your 
tray  thus,  to  within  an  eighth  of  an  inch  of  the 
gums  all  around ;  and  always  sh}'  of  the  attach- 
ing muscles  of  the  lip  and  cheek,  so  the  metal 
won't  strain  them  in  the  least. 

Don't  let  your  metal  tray  iTin  up  high  be- 


28  Greene  Brothers'  Clinical  Course 

hind  the  tuberosities  so  as  to  strain  the  tissues 
there.  Bear  in  mind,  I  repeat,  your  metal  tray 
mustn't  strain  the  tissues  anywhere;  especially 
not  the  muscular  tissues.  (Stick  a  pin  in  that 
essential  fact.) 

After  long  effort,  I  have  succeeded  in  getting 
some  Greene'Method  tra3^s  made  on  purpose  for 
those  who  may  learn  their  advantage.  There 
are  for  tjie  present  nine  in  a  set;  and  so  shallow 
in  depth,  and  otherwise  so  shaped,  as  to  re- 
quire a  minimum  of  change.  They  are  manu- 
factured by  the  Detroit  Dental  Manufacturing 
Company,  Detroit,  Mich.  While  you  can  cut 
your  old  trays  down  and  shape  them,  as  I  show 
you,  you  can  get  more  appropriate  new  ones. 
Some  of  ours  have  removable  handles,  the  ad- 
vantages to  be  shown  later  on. 

The  Fitted  Metal  Tray. 

Now  you  have  fitted  3^our  metal  tray,  either 
to  the  approximate  model  or  to  the  mouth  it- 
self, in  a  way  to  leave  space=room  for  your  com- 
pound to  hide  it  (the  tray)  when  your  coiTCct- 
able  impression  is  first  taken.  That  is,  the  im- 
pression material  must  cover  the  metal  trays 
all  over.  The  metal  can't  be  manipulated;  the 
material  can  be — one  reason  for  low=rimmed 
trays. 

Be  sure  your  tray  either  has  holes  through 
it  or  else  is  well  smeared  with  actually  adher- 
ing compound  before  you  place  that  for  the 
impression  on  it,  to  insure  sticking  safely.  And 
I  '11  here  remark  in  advance:  Be  especially  care- 
ful in  fastening  impressions  to  trays  in  partial 
cases. 


IN  Dental  Prosthesis. 


29 


Fig.  I. — Average  deep  tray  before  cut  down  and  fitted  to  the 
mouth.  Its  high  rim  would  distort  the  tissues.  All  trimming  of 
plates  from  impressions  in  it  must  be  by  unreliable  file-guess-work. 

Fig.  2. — Same  tray  after  cut  down  and  fitted  to  the  mouth. 
Can  be  deepened,  if  necessary,  with  modeling  compound  traced  from 
Kerr's  tracing-sticks.  Then  the  impression  rim  can  be  accurately 
muscle-trimmed . 


Handle  can  be  removed  for  muscle-trimming,  and  li 
impression  fills  out  the  lips  and  cheeks. 


show  how 


30  Grijene  Brothers'  Clinical  Course 

Now  Take  Your  Correctable 
Impression. 

This  I  will  first  illustrate  in  detail.  Then, 
when  you  understand  it  in  detail,  I  '11  unite 
these  details  as  we  'd  do  it  in  a  practical  op- 
eration. You  '11  combine  as  many  details  as 
your  case  and  your  experience  may  warrant. 
But  first  learn  the  principles  in  dissection  and 
practice  them  in  detail,  till  you  can  safely  unite 
them. 

Two  Methods  of  Taking  Correctable 
Impressions. 

We  also  teach  two  methods  of  taking  a  cor- 
rectable impression: 

{a)  The  student's  method,  and 

ib)  The  practitioner's  method. 

The  practitioner  can  often  use  the  student's 
method  to  advantage,  but  the  novice  in 
impression=taking  would  best  learn  by  the  stu- 
dent's method. 

Student's  Correctable  Impression, 

Take  your  now  fitted  tray,  with  its  low  rim 
and  short  rear,  and  take  an  impression  of  the 
same  model  you  fitted  the  tray  to.  This  will 
give  you  an  approximate  impression  with  a  mar- 
gin of  material  above  the  metal  rim  and  behind 
the  metal  tray.  It  will  be  so  lacking  as  not  to 
deserve  the  name  "impression."  It  '11  be  merely 
a  modeling= composition  tray.  It  will,  however, 
be  your  student's  correctable  impression. 

To  take  this  correctable  impression  of  the 
model,  you  first  dust  it  with  flour  of  soapstone, 
so  the  impression  won't  stick  to  it.  ''And  don't 
you  forget  it! ' ' 

To  separate  them,  you  first  chill  the  im- 
pression a  little;  then  pull  it  away  a  little  bit 
from  the  model  at  the  heel,  or  tuberositv.    Then 


IN  Dental  Prosthesis.  31 

quick=dip  in  cold  water  to  let  it  (the  water)  in 
between  the  impression  and  model,  and  very 
quickly  hard=squeeze  them  back  together,  to  re- 
store shape  to  the  impression;  for  it  probably 
sprung  some  in  the  partial  removal.  Then  take 
the  model  out  of  the  impression  and  cool  it 
thoroughly.  Should  you  neglect  to  pull  the  im- 
pression a  little  away  from  the  model  while  it 
is  yet  warm  in  the  interior,  as  shown,  you  may 
have  difficulty  in  getting  it  off  when  cold. 

The  next  thing  would  be  to  transform  this 
correctable  impression,  or  compound  tray,  into 
a  perfect  tested  impression.  But  before  we  do 
it,  we  '11  take  uv 

(First  Step.) 

The  Practitioner's  Approximate 
Impression. 

So  now  we  '11  stop  to  take  a  similar  cor- 
rectable impression  by  the  practitioner's  (cut= 
short)  method.  Then  we  '11  fit  each  of  these 
approximate  impressions  to  the  mouth,  in  about 
the  same  manner. 

To  take  a  correctable  impression  from  the 
mouth  (practitioner's  way),  instead  of  from  the 
approximate  model  (student's  wa}'),  place  the 
' '  Perfection ' '  compound  in  a  small  pan  of  water 
with  rubber  dam  under  it  to  prevent  sticking. 
Heat  it  some,  but  not  hot  enough  to  scald  your 
fingers. 

With  your  hands  and  fingers  well  wet,  roll 
the  material  into  a  ball;  place  it  in  tray,  finger= 
press  or  fashion  it  to  approximately  fit  the 
mouth,  but  cone=shaped  in  center,  with  full=high 
rim  all  around . 

The  cone=shape  is  to  insure  its  striking  the 
center  of  the  mouth  first  and  scattering  out- 
wardly ;  a  matter  of  especial  importance  in  deep 
arches. 


32  Greene  Brothers'  Cunicai,  Course 

With  your  material  well  shaped,  now  pass 
it  back  and  forth,  laterally,  over  a  small  hand= 
spirit=lamp  flame,  to  soften  the  surface  to  a 
semi=flowing  consistency,  not  quite  hot  enough 
to  bum  your  fingers  at  a  test=touch.  Always 
have  your  fingers  wet  with  warm  water.  Tell 
your  patient  it  's  quite  warm,  but  not  hot 
enough  to  bum.     Don't  forget  this  precaution! 

Now,  with  your  left  arm  around  your  pa- 
tient's head  (her  head  forward  rather  than  back- 
ward) and  the  long  finger  of  your  right  hand 
in  the  under=center  of  the  tray,  push  upward 
gently,  with  an  up=and=down  wave=like  motion ; 
an  upward  spring-like  pressure,  mind  3^ou. 

Push  lightly,  for  impressions  should  be  taken 
at  about  the  strain  plates  are  to  be  worn.  (This 
point  is  worth  repeating.) 

If  the  roof  of  the  mouth  is  deep,  pull  for- 
ward a  little  while  you  are  playing  upward,  in 
order  to  strike  the  front  palate  right=angle=ward ; 
for  modeling=composition  impressions  should  be 
taken  at  about  right  angles  at  all  points,  as  well 
as  at  about  normal  plate=pressure. 

When  you  have  it  pushed  to  place,  hold  it 
steadily  until  you  reach  around  to  the  right 
side  of  the  face  and  with  the  index  finger  of 
of  the  left  hand  adroitly  flip  up  the  squashed 
material  that  overlaps  the  rim  of  the  metal 
tray  there. 

Then  remove  your  right=hand  central  finger, 
aforesaid,  and  dextrously  change  off  to  your 
left-hand  middle  finger,  in  place  of  the  right= 
hand  one.  Hold  as  before  while  30U  reach 
around  and  flip-  up  the  left  overlapping  ledge 
with  the  right=hand  index  finger.  (Don't  get 
hands  and  fingers  mixed  up.) 

I  mean  quickly  push  the  compound  up  above 
the  edge  of  the  tray  all  around;  but  not  tightly 
against  the  gums — for  reason  given  later  on. 


IN  Dental  Prosthesis.  33 

Now,  right  away,  while  the  material  is  still 
soft,  tell  patient — and  show  her  how — to  work 
the  rim  of  the  impression  down  by  lip=and=cheek 
motion.  By  prompt  movement  of  your  own 
lips  you  will  prompt  her.  (And  you  must  do 
this  familiarly  yourself  to  impress  your  patient 
to  do  it.     Get  before  a  inirror  and  practice.) 

Hold  up  impression  firmly  with  your  right = 
hand  middle  finger  while  patient  gets  a  quick 
move  on  her  and  obe^^s  orders. 

Ihis  lip=and=cheek  movement  gives  you  the 
approximate  height  of  the  impression — not  the 
exact  height. 

Now  to  cool  it.  Again  change  to  left  finger 
and  hold  w^hile  with  your  right  hand  you  reach 
to  your  cup  of  cold  water  and  get  a  little  sponge, 
about  the  size  of  a  small  black  walnut,  and  hold 
it,  ice=cold,  up  against  the  under  roof  of  the 
metal  tray  for  a  full  half=minute,  to  cool  the 
impression. 

Practitioner's  Partial  Test  for  Fit. 

When  cold,  let  go  the  tray.  If  the  impres- 
sion stays  in  place  (without  any  muscular  move- 
ment to  dislodge  it),  that  proves  it  fits  the  roof 
and  alveolar  ridge;    all  the  fit  you  want  now. 

You  know  it  fits  there,  because  it  stag's  up 
without  fitting  anywhere  else.  You  've  never 
pressed  it  to  the  gums  on  the  side  nor  at  the 
back  palate;  hence  the  stick  must  be  at  the 
center  and  on  the  ridge — just  what  you  want 
for  the  present. 

This  is  the  test  for  the  center  and  ridge  fit. 
And  I  '11  assure  you  that  if  you  do  this,  as  I  've 
told  you  and  here  shown  3^ou,  3'ou  '11  not  fail 
to  get  this  center=fit  once  in  fifty  times.  That 
is,  to  repeat,  by  coning=up  your  material  in  the 
center,  warming  it  to  a  half = flowing  condition 
over  a  spirit  flame  and  pressing  it  up  by  wave= 
motion,  at  noniial  wearing  plate=pressure. 


34  Gree;ne  Brothers'  Cunicaiv  Course 

Now  you  've  taken  your  correctable  impres- 
sion by  the  practitioner's  method ;  and  you  have 
about  the  same  results  as  by  the  student's,  meth- 
od, only  that  you  have  a  tested  fit  to  the  roof 
and  ridge,  which  the  student  hasn't. 

Suppose  It  Doesn't  Center=Test. 

Btit  now,  doctors,  for  convenience  of  in- 
struction, we  '11  suppose  that  once  in  a  while 
we  may  fail  to  get  this  roof=fit  by  the  practi- 
tioner's method.  We  '11  then  first  get  the  ex- 
act length  which  the  plate  is  to  be  at  the  back 
palate,  and  proceed  to  correct  the  roof  and  ridge 
till  it  does  test=fit. 

Mark  this  point  in  our  work:  We  make  no 
roof  correction  until  we  first  get  the  exact  length 
of  our  impression  at  the  rear.  Nor  do  we  do 
both,  the  correction  and  getting  the  length,  at 
the  same  step  into  the  mouth. 

{Second  Step.) 

Trim  It  Approximately. 

We  have  before  us'  our  correctable  impres- 
sion. In  this  case  it  fits  nowhere  correctly  yet. 
Now,  our  second  step  is  to  complete  its  ap- 
proximate trimming. 

Its  rim  has  already  been  trimmed  approx- 
imately, as  to  height,  by  the  lip=and=cheek  mo- 
tion of  our  patient,  "Madam"  (usually  one  of 
the  class);  but  its  sides  are  thicker  than  we  '11 
want  them  to  be  in  our  next  move,  so  we  '11 
thin  them  down  a  little. 

I  will  touch  the  sides  slightly  to  this  man- 
ageable hand=lamp  flame  and  shave  them  down 
with  this  sharp  pocket=knife  to  about  three  or 
four  times  the  thickness  we  'd  want  an  ordi- 
nary finished  plate  to  be.  We  warm  it  very 
slightly  to  cut  more  easily. 

Next,  we  '11  cut  the  impression  off  at  the 


IN  Dental  Prosti-iesis.  35 

rear,  leaving  it  a  little  longer  than  we  think 
our  finished  plate  should  be;  say  at  least  an 
eighth  of  an  inch  too  long.  If  it  weren't  that 
long,  we  'd  take  a  tracing=stick  of  Kerr's  "Per- 
fection" material  (same  as  the  rest  of  the  im- 
pression) arid  trace=on  to  wanted  length.  (Here 
the  fine  art  of  tracing=on  is  shown  objectively 
to  the  deep  interest  of  the  class.) 

But  now,  before  we  show  how  to  get  the 
exact  length  of  a  plate  at  the  rear,  we  must 
understand  what  length  it  should  be.  That  is 
one  of  the  most  important  matters  in  plate= 
work — if  a  roof  is  to  be  left  at  all.  In  many 
mouths  a  roof  isn't  at  all  necessary;  and  in 
some  actually  detrimental.  But  where  used, 
the  exact  extent  is  often  a  very  close  point  to 
make. 

In  some  mouths  even  an  eighth  of  an  inch 
or  less  would  cause  sticktion,  or  prevent  it;  then 
again,  in  others  we  have  a  latitude  of  a  quar- 
ter or  third  of  an  inch  margin  to  go  on. 

What  we  want  is  to  reach  onto  the  station- 
ary soft  parts  and  yet  not  onto  the  movable 
soft  parts. 

If  we  don't  get  onto  the  yieldable  soft  and 
press  it  up,  our  plate  will  tip  down  behind  eas- 
ily. And  if  we  get  onto  the  movable  soft,  it 
may  move  and  push  the  plate  down;  or,  at 
least,  cause  "gagging." 

Now,  can  we  make  that  fine  line  of  demark- 
ation  between  the  stationary  soft  and  the  mov- 
able soft  tissues  at  the  rear  of  our  impression? 
If  we  can't,  we  may  fail. 

To  Get  Length  of  Plate  in  a 
Soft  Mouth. 

If  the  mouth  is  what  we  call  a  soft  one  (no 
hard  palate),  we  find  this  line  with  close  pre- 
cision bv  the  ordinarv  swallowing:  movement. 


36  Greene  Brothers'  Clinical  Course 

That  is,  we  thin  down  the  impression  from  the 
under  side  (it  purposely  being  a  httle  longer 
than  the  metal  tray)  until  the  edge  is,  say,  an 
eighth  of  an  inch  or  so  thick,  and  a  little  bit 
longer  than  we  think  a  plate  should  be  in  that 
mouth. 

Then  we  warm  this  thin,  projecting  edge  at 
the  side  of  the  little  spiritdamp  flame  till  it 
will  yield  readily  to  the  touch  of  our  finger, 
but  not  bum  it. 

Ihen  we  slip  the  impression  into  the  mouth 
quickly  and  have  patient  bite  down  on  our  fin- 
ger and  promptly  swallow  a  time  or  two.  She 
has  to  bite  down  on  something  to  enable  her 
to  a  good  effort. 

Now  she  has  swallowed  boldly.  We  take 
the  impression  out  and  find  the  rear  of  it  turned 
down,  as  far  as  the  moving  parts  moved;  and 
only  that  far. 

We  chill  it  in  cold  water  and  trim  off  to 
where  it  turns  down.  We  may  do  this  a  sec- 
ond, or  even  a  third  time,  if  necessary  to  make 
sure  of  the  all= important  point. 

This  procedure  will  give  us  the  proper  length 
of  the  plate  ninety  or  more  times  in  a  hundred, 
if  done  rightly.  And  in  the  other  ten  or  less 
times  in  a  hundred  the  failure  would  show  up 
when  we  made  our  final  test  of  finished  im- 
pression;  which  we  can  then  correct. 

(The  process  is  here  shown  closely  to  each 
one  in  the  class.) 

To  Find  Length  for  Plate  Over  a 
Hard  Palate. 

The  method  just  described  is  for  a  mouth 
with  a  soft  roof.  We  have  an  easier  and  quick- 
er way  of  finding  the  length  of  an  impression 
(or  plate)  in  a  mouth  with  a  hard  palate. 

Doctors,  you  have  never  taken  an  impres- 


IN  Dental  Prosthesis.  37 

sion  of  a  hard=palate  mouth  that  didn't  show 
just  where  the  hard  reached  to.  You  can  gen- 
erally see  it  quite  plainly.  And  such  an  im- 
pression alw^ays  tells  you  itself  just  where  to 
cut  it  off;  at  least,  where  not  to  cut  it  off.  That 
it  will  not  do  to  cut  it  off  on  the  hard  part 
will  bear  repeating — several  times  if  necessary. 
It  'd  then  easily  tip. 

Cut  it  off  at  least  one=eighth  of  an  inch  back 
behind  the  limit  of  the  hard  part;  even  a  quar- 
ter of  an  inch  is  often  advisable.  Just  so  you 
don't  let  it  reach  onto  the  movable  soft  part; 
in  which  case  it  would  "swallow  down,"  or 
^' gag  "badly. 

To  repeat  the  mle:  Reach  onto  the  station- 
ary soft  part  without  encroaching  onto  the  mov- 
able soft  part.  Ihis  valve=pressure=line  demark- 
ation  is  always  an  eighth  of  an  inch  wide — 
generally  more.  Pretty  soon  I  '11  show  you 
how  I  make  the  essential  valve  pressure  thereon. 

And  a  little  prematurely  I  '11  here  mention 
that  we  must  reach  the  soft  tissue  and  make  this 
coming  valve =pressure  fit  extend  clear  around 
on  the  plate  =  to  =  be — behind  the  tuberosities 
and  all. 

We  must  have  an  equalized=pressure  fit  all 
over  it  and,  additionally,  a  valve=pressure  fit 
all  around  the  edges.  We  must,  by  detail  when 
necessar}^  transform  the  non=fitting,  correctable 
impression  wholly  into  a  con-ect  one  and  test 
it  finally  to  know  that  it  is  correct  CA^ery where. 

We  now  have  the  rules  for  finding  the  length 
of  an  impression  (consequently  plate)  for  either 
a  hard  or  soft  palate.  We  class  the  medium 
with  a  soft  palate.  A  hard  one  is  where  you 
can  see  in  the  impression  of  any  proper  ma- 
terial just  where  the  hard  reaches  to. 


38  Greene  Brothers'  Ceinical  Course 

(Third  Step.) 
Correct  Roof  to  Test=Fit. 

We  now  have  the  approximate  height  of  rim 
and  true  length  of  impression.  However,  if  at 
any  point  the  rim  is  lacking,  we  '11  just  trace=on 
as  much  as  is  needed,  as  I  have  shown  you. 

This  tracings  on  of  additional  material  will 
be  more  frequently  required  behind  tuberosities 
than  anywhere  else,  because  in  some  mouths 
you  can't,  in  the  first  place,  get  your  finger  up 
there  in  the  mouth  to  push  it  up. 

We  '11  first  trace=on  the  required  material 
and  then  approximately  place  it,  with  wet  fin- 
gers. We  '11  adjust  it  correctly  when  we  so  treat 
the  rest  of  the  rim. 

Now  we  are  ready  to  make  the  correct  fit 
to  the  roof  and  ridge,  which  should  have  been 
accomplished  when  we  first  took  our  correct- 
able impression,  and  which  will  be  accomplished 
ninety-five  times  in  a  hundred  if  done  as  shown 
you.  Well,  this  roof  correction  is  quickly  and 
easily  made. 

We  have  here  a  common  tin=cup  with  a  spout 
like  that  of  a  teapot,  near  its  top,  that  will  pour 
a  stream  about  the  size  of  a  six=penny  nail. 
From  it  we  pour  hot  water  into  the  impression 
until  it  fills  up  to  within  an  eighth  of  an  inch 
from  the  top. 

We  pour  on  and  on,  the  hot  water  running 
off  at  the  heel.  W^e  '11  not  heat  quite  to  the 
top  of  the  rim,  however;  the  patient's  lips  would 
then  turn  it  over  the  wrong  way  when  we  'd 
insert  it  in  her  mouth. 

We  '11  get  the  center  as  soft  as  we  can  with- 
out burning  the  mouth.  And  here  the  Kerr 
"Perfection"  has  rare  possibilities.  We  quick- 
ly insert  it  and  immediately  wave=press  lightly — - 
quickly,  for  haste  here  is  absolutely  essential  to 


IN  Dental  Prosthesis.  39 

success.  To  simply  see  this  is  to  learn  how; 
but  with  slow  people  sufficient  quickness  may 
have  to  be  acquired  by  practice. 

Now,  the  question  simply  is:  Can  yon  do 
this  quickly  enough?  If  not,  why,  then  not  at 
all.  No  physical  stupidity  nor  poke=and=go= 
easiness  will  fit  in  here.  If  you  can,  you  '11 
seldom  fail  in  the  first  effort. 

But  the  hot=pot  pouring  and  other  efforts 
must  be  repeated  until  the  impression  will  stand 
a  roof=fit  test;  i.  e.,  hang  there  snugly,  with  no 
muscular  movement  to  loosen  it. 

Take  notice,  now,  if  we  have  made  much 
change  in  the  impression  in  this  equalizing  work; 
we  may  find  a  little  bit  of  a  roll  of  compound 
showing  up  where  the  hot  and  cold  points  met 
on  the  inside  of  the  rim.  If  so,  we  '11  scrape 
it  off  down  even,  before  we  forget  it. 

While  this  roof = correcting  step  is  very  sel- 
dom necessary  in  the  practitioner's  method,  it 
is  very  frequently  needed  with  the  student's 
method.  It  depends  on  whether  or  not  the 
compound  is  coned=up  in  the  center,  softened 
thoroughly,  and  pushed  up  with  right  motion 
at  a  proper  angle  and  due  strain. 

I  'd  like  to  both  whisper  and  "holler"  these 
essentials  in  the  ears  of  all  plate=making  dent- 
ists.    I  could  save  them  so  much  trouble. 

{Fourth  Step.) 

Correct  Rim  to  Muscles. 

This  is  to  get  the  precise  height  of  the  plate= 
rim.  everywhere,  including  behind  tuberosity,  and 
especially  to  get  a  correct  fit  to  the  moving, 
straining  tissues. 

I  don't  mean  to  get  for  them  merely  relief 
from  strain,  but  a  sort  of  accommodating  pres- 
sure to  them,  with  ample  room  for  air= tight 
movement.     We  christen  the  gratif^^ing  result 


40  Greexe  Brothers'  Clinical  Course 

"  Relief=Without=Leak" — the  Perfection 

Compound  Impression 

Pass=Word. 

We  accomplish  the  precision  in  part  by  a 
system  of  muscle= trimming  on  sensitized  edges. 
We  take  our  approximately  trimmed  impression, 
warm  the  edge  of  the  rim  slightly  all  around, 
including  tuberosities,  and  pinch  it  up  a  little. 
This  purposely  brings  it  up  a  little  too  high 
and  somewhat  thin  at  its  very  top. 

This  extra  high  rim  we  now  warm  quite  soft 
to  a  ver}'  shallow  depth,  insert  it  in  the  mouth, 
and  with  quick,  positive  movements  of  the  lips 
and  cheeks  work  it  down  to  the  proper  height, 
to  fit  the  moving  muscles. 

This  I  give  you  as  an  advance,  hurried  pre- 
lude to  what  we  do.  Xext  I  "11  '^ show''  you. 
(From  Missouri.; 

Now  watch  me  closely.  By  the  side  of 
this  little  hand=spirit=lamp  flame  I  warm  this 
pinched=up  edge  (one  side  at  a  time  in  many 
casesj  very  soft  to  the  depth  of  about  an  eighth 
of  an  inch. 

Now  I  '11  slip  it  into  the  mouth  very  quickly, 
and  have  patient  promptly  make  all  possible 
movements  of  her  lips  and  cheeks  that  she  'd 
make  in  wearing  a  plate.  I  usually  do  this  one 
side  at  a  time. 

Take  notice:  (a)  very  soft;  ih)  to  a  very 
shallow  depth;  and  ic)  all  done  very  quickly. 
Three  "very"s.  "Stick  a  pin"  in  to  hold  these 
three  "very"s! 

Well,  to  impress  you  I  '11  baptise  this  stunt 
in  New  River  and  name  it 

VERY-EDGIXG  or  MUSCLE-TRIMMIXG. 

So  I  have  trimmed  the  rim  of  the  impres- 
sion, hence  the  plate,  too,  by  muscle  movement. 
Every  tissue,  hard  and  soft,  has  cut  its  way  into 


IN  Dental  Prosthesis.  41 

this  ' '  very  "  soft  rim  (over  a  hard  under  stratum) 
and  has  room  for  free  pressure  movement. 

Sometimes  this  has  to  be  repeated,  and  par- 
ticular points  especially  warmed,  to  get  the 
trimming  exact.  But  persistence  is  sure  to 
bring  accurate  results. 

' '  Quick  work ! ' '  Yes ,  it  is  quick  W(*)rk .  And , 
by  the  wa}^  3'"ou  can,  by  this  very  =  edging 
process,  trim  an  im^pression  (hence  the  plate) 
more  than  ten  times  quicker  than  you  could 
file  =  trim  a  plate,  not  considering  the  incom- 
parably greater  accurac}'  in  favor  of  muscle= 
trimming. 

Each  one  of  you  will  have  to  practice  and 
get  the  move  on  your  own  face,  to  show  ^^our 
patients.  You.  can't  merel}"  tell  all  what  to  do. 
Some  must  be  "shown." 

Then,  once  in  a  while,  you  may  have  to 
train  a  patient — not  only  to  act,  but  to  act 
promptly,  before  3^ou  attempt  the  practical  ac- 
tion of  her  face. 

If  one  attempts  to  joke  and  say  and  do 
funny  things,  just  look  stolid  and  don't  smile, 
btit  frown  at  her  "monkeying."  Give  her  to  un- 
derstand that  you  are  in  earnest,  and  she  soon 
will  be. 

Until  you  become  familiar  with  this  part  of 
the  work  you  may  have  to  "very=edge"  one 
side  at  a  time,  always  entering  into  the  mouth 
on  the  opposite  side  from  the  softened  rim. 
This  to  prevent  the  cheek  from  mal=pressing 
the  softened  edge. 

Be  careful  to  soften  properly  behind  tuber- 
osities. There  the  muscles,  sometimes  string}^ 
will  press  down  onto  the  soft  material  and 
do  their  own  trimming,  without  much,  if  any, 
straining  motion.  In  your  hurry  don't  forget 
this  point,  behind  and  around  the  "heel  knobs." 


42  Greene;  Brothers'  Clinical  Course 

To  Especially  Fit  Particular  Muscles. 

As  a  matter  of  importance,  I  '11  here  again 
repeat:  If  anywhere,  at  any  time,  you  should 
see  on  3' our  partially  "  very=edged  "  rim  indica- 
tions of  muscle  strain,  just  re=warm  that  par- 
ticular spot  "very  shallow"  at  the  side  of  your 
spirit  flame,  or,  better,  with  a  mouth  blowpipe, 
and  hurry  it  into  the  mouth  and  have  patient 
work  that  muscle  promptly. 

If  she  is  too  slow,  assist  her  motion  with 
3'^our  fingers.  But  better  first  train  her  to  her 
own  movement,  whenever  a^ou  can. 

While  attending  to  special  parts,  don't  for- 
get the  upper  fraenum.  You  '11  be  surprised- 
at  both  the  quickness  and  accurac}^  of  results. 
Unless  individual  muscles  need  special  atten- 
tion, you  can  accurately  trim  an  impression 
(consequently  the  plate)  in  a  few  seconds. 

Bear  in  mind:  When  you  muscle=trim  a 
rim=edge,  it  is,  with  rare  exceptions,  left  high 
enough  to  reach  beyond  the  hard  parts  onto 
the  soft  and  yieldable  tissues.  Only  on.  such 
you  can  get  valve=pressure  fits. 

(Here  in  the  class  Course  we  show  the  very= 
edging  process,  in  minute  detail,  on  our  own 
practical  plate,  in  our  own  mouth;  always  to 
the  gratif34ng  surprise  of  the  old  =  way  file- 
trimmers.) 

vSomeone  asks :  ' '  How  much  should  this  be 
done  in  a  given  case?"  Why,  just  till  the  or- 
dinary and  natural  movements  of  the  cheek 
and  lips  fail  to  cut  any  deeper  into  the  "very 
softened"  material. 

W.hen  a  plate  is  trimmed  to  stand  the  ordi- 
nary movements  of  the  mouth  and  face,  the 
wearer  will  soon  learn  to  avoid  extraordinary 
ones,  or  even  to  safely  make  them,  in  practical 
use. 


IN  Dental  Prosthesis.  43 

{Fifth  Step.) 
Conform  Compound  to  Soft  Parts. 

Your  impression  reaches  up  onto  the  yield- 
able  tissues,  on  which  you  are  to  make  an 
equalized  valve=pressure  strain  against  the  in- 
ner side  of  the  impression  rim  at  its  top. 

While  the  tissue  reached  is  generally  yield- 
ing, it  ma}"  still  be  harder  in  some  places  than 
at  others;  and  it  is  on  these  different  textures 
yOu  want  to  equalize  strain.  That  is,  press 
against  the  soft  parts,  between  the  harder  ones, 
so  as  to  get  an  air=tight  fit  on  the  soft  places, 
as  well  as  on  the  harder  ones. 

To  do  this,  you  simph',  but  slightly,  w^arm 
that  part  of  the  impression  that  is  above  the 
metal  tra}^  and  press  gently,  but  firmly,  hori- 
zontalh^  against  these  soft  parts,  and  cool  it 
there  while  under  strain.  I  emphasize:  while' 
under  strain;  otherwise  the  material  might  re- 
bound, when  you  'd  lose  your  pressure. 

Conforming  is  the  name  we  give  this  right = 
angle =pressure  operation.  While  it  is  ver}'  sim- 
ple, it  requires  nicety  of  manipulation  and  care; 
nicety  to  do  it  and  care  not  to  afterward  ttndo  it. 

It  requires  more  experience  to  properly  con- 
form the  rim  of  an  impression  to  the  tissues 
than  to  do  any  other  one  thing  I  '11  show  you 
in  this  whole  Course  of  seven  to  nine  hours. 

But  I  hope  3"0u  '11  not  object  to  some  nicety 
of  operation  and  carefulness  as  long  as  less  is 
asked  of  you  than  you  require  of  the  man  who 
shaves  you.  Should  you  hestitate  at  simple 
trained  touches  like  this,  then  never  attempt 
the  keener  technics  of  tonsorial  artistry. 

But  let  's  do  it.  Watch  me  warm  the  rim 
of  this  upper  impression  (on  the  left  side)  by 
passing  it  back  and  forth  over^  this  hand=lamp. 
I  'm  slowly  warming  it  through  from  the  outer. 


44  Greene  Brothers'  Cunical  Course 

side  inwardly;  all  of  it  from  the  metal  tray 
upward. 

I  '11  miildly  warmt  it  from,  the  front = center 
clear  around  behind  the  tuberosity  till  it  reaches 
about  the  softness  of  the  palm  of  my  hands. 
I  test  its  yieldance  with  my  finger — it 's  ready! 
I  slip  it  into  the  mouth  and  hold  it  up  with 
the  long  finger  of  my  right  hand,  and  press 
gentl}^  to  the  left  cheek  outside,  with  my  left 
thumb  =  and  =  hand,  clear  around  to  the  front= 
center. 

See  ?  My  thumb=hand  just  fits  the  madam's 
face  as  if  it  'd  been  made  for  the  purpose.  I 
push  squarely  against  the  cheek  and  on  the 
front  lip,  and  hold  it  so  for  about  a  minute. 
By  that  time  the  "Perfection"  material  will 
have  ' '  set ' '  enough  to  prevent  rebounding  when 
I  remove  my  thumb. 

"Hold  still,  Madam;  don't  move  a  muscle!'' 
I  reach  over  and  dip  my  left=hand  index  fin- 
ger (clean=cloth=stall=covered)  into  my  near=by 
cold= water  cup  and  hasten  to  reach  in  under 
the  lip  and  cheek  (left  side)  and  cool  my  now= 
conformed  rim  with  a  little  pressure. 

If  I  have  an  assistant,  I  have  her  do  the 
cooling  with  a  small  syringe.  But  bear  in  mind, 
the  cooling  should  be  done  while  the  pressure 
is  on,  for  fear  of  rebound. 

(We  have  no  long  handles  on  our  trays  to 
be  in  the  way.  Ours  are  either  about  three= 
fourths  of  an  inch  long  horizontally,  or  one= 
fourth  turned  down  perpendicularly;  or  wholly 
removable,  when  no  longer  needed. 

Next,  conform  the  opposite  side  in  the  same 
way.  But  here  one  special  caution,  doctors: 
after  you  have  conformed  one  side  of  the  im- 
pression, don't  push  it  off  from  its  gum  when 
you  conform  the  opposite  side,  and  by  so  doing 


IX  Dextal  Prosthesis.  45 

make,  a  side=sHpping  impression.     This  relates 
particularly  to  flat  mouths. 

In  a  big  mouth,  with  thin  lips,  we  can  con- 
form both  sides,  and  in  front,  too,  all  at  the 
same  time.  Then  there  's  no  danger  of  uncon- 
forming one  side  while  we  conform  the  opposite 
side.  I  sometimes  thus  conform  both  sides  and 
in  front  all  at  the  same  squeeze,  by  clamping 
the  whole  face  between  my  thumb  and  index 
finger  of  my  right  hand,  while  I  hold  the  im- 
pression up  to  place  with  my  left  index  finger; 
or  vice  versa. 

Say,  doctors,  when  you  have  conformed  the 
rim  of  an  impression  all  around  to  the  sides 
of  the  alveolar  ridge  properly,  you  have  indeed 
accomplished  a  most  valuable  operation. 

Now,  we  '11  go  on  and  gently  warm  the  heel= 
comers,  return  it  to  the  mouth  and  hold  it  to 
place  with  our  left=hand  middle  finger,  while 
with  our  right  index  finger,  cloth= covered,  we 
reach  up  behind  the  tuberosities  and  conform 
there  genth'',  too.  We  finger  under  and  around 
by  way  of  the  palate  usually,  but  sometimes 
via  the  more  cramped  cheek  passage. 

It  is  all  =  important,  especially  in  cases  of 
roofless  plates,  that  dentures  fit  up  snugly,  with- 
out undue  pressure,  around  these  prominences. 
It  is  essential  to  roofless  plates. 

We  sometimes  have  such=like  conformation 
made  b}^  the  patient's  tongue,  cooling  it  well 
before  removal,  after  held  to  place  to  set  a 
minute  or  so. 

It  is  fine  work  to  properly  fit  a  plate  around 
tuberosities;  but  when  done,  it  won't  easily  tip 
down  behind  when  bitten=on  in  front.  Now 
clinch  this  heel=knob  pointer  in  your  minds: 

No  language  can  over=praise  the  results  of 
proper  conformation  of  the  rim  of  a  plate  to  the 
yielding  tissues! 


46  Greene  Brothers'  Cunicae  Course 

(Sixth  Step.) 
Conform  ("Post=Dam")  Back  Palate. 

Now  all  parts  of  our  correctable  impression 
have  been  fitted  to  the  parts,  excepting  the 
back  palate.  As  this  is  really  the  most  import- 
ant point  for  adjustment  in  the  whole  mouth, 
I  have  left  it  till  the  last. 

The  impression  material  purposely  reaches, 
as  you  understand,  a  little  back  beyond  the 
metal  tray;  so  the  shortness  of  the  metal  gives 
room  for  a  little  cut=out  of  material  under  the 
end  of  the  impression,  leaving  it  thin=like  there, 
similar  to  the  rim. 

Now,  let  us  slightly  warm  this  over=projec- 
tion,  as  we  did  that  above  the  metal  rim,  so 
we  can  conform  it  to  the  3deldable  tissues,  onto 
which  it  reaches. 

I  instruct  my  patient:  ' '  Now,  Madam,  when 
I  put  this  impression  into  your  mouth,  I  want 
you  to  press  it  up  gently,  but  rather  firmly,  at 
the  back  part,  with  your  tongue,  and  hold  it 
there  a  minute  till  I  snap  m}^  finger."  When 
"set"  enough  to  not  yield  back,  she  drops  her 
tongue;  and  I  finish  with  cold=finger  pressure, 
same  as  I  did  the  upper  rim. 

The  tongue  being  soft,  it  presses  the  soft 
material  against  the  soft,  yieldable  tissue  to 
exactness.  If  there  are  an 3^  granular  or  hard 
spots  back  there,  as  often  there  are,  the  press- 
ure equalizes  the  strain  against  them  and  be- 
tween them. 

There  is  now  a  little  general  up=push  all 
along  the  yielding  line;  a  little  valve=like  press- 
ure that  precludes  air  passage  under  it. 

Study  well  the  rules  and  practice  the  meth- 
ods of  finding  this  exact  right  reach  of  your 
plate.     (Index  L.) 

Method  A,  by  tongue  pressure,  is  the  way 


IN  Dental  Prosthesis.  47 

I  've  shown  3^ou  to  conform  a  modelings  com- 
pound impression  to  the  post=palate. 

It  is  my  preferable  way,  and  my  general 
way  under  favorable  conditions.  But  some- 
times we  have  deaf  people  and  sometimes  non= 
English=speaking  people  to  deal  with.  (Some- 
one says:  "Yes,  and  dam=phools!")  Well,  we 
must  have  a  way  to  post=dam,  in  such  cases, 
without  the  patient's  help. 

Method  B,  by  roof  pressure.  This  we  do 
by  warming  the  rear  of  the  impression,  as  in 
Method  A,  and  then  turning  it  up  a  little  too 
high  and  pressing  it  up  against  the  roof  of  the 
mouth,  when  the  tissues  will  push  it  back,  still 
leaving  some  valve=like  pressure.  Of  course, 
w^e  cool  as  before. 

While  Method  B  isn't  as  accurate  as  Method 
A,  it  is  far  more  so  than  any  of  the  old  scraping 
and  grooving  ways  of  getting  rear  pressure.  In- 
deed, in  many  cases  of  granular  palates,  scraping 
and  grooving  for  rear  pressure  won't  do  at  all. 
Guess=work  is  rarely  exactly  correct  at  the  best. 

Method  C  is  the  third  way  of  post=damming; 
that  is  by  finger  pressure.  We  warm  as  before, 
but  scarcely  as  soft  as  in  A  and  B,  and  press 
it  up  and  cool  it  with  clean=cloth= covered  in- 
dex digit  of  right  hand,  at  same  time  holding 
impression  to  place  with  the  long  finger  of  the 
left  hand. 

With  experience  and  carefulness.  Method  C 
is  easily  accomplished  and  will  succeed  fairly 
well  when  there  are  no  granules,  or  bumps, 
under  the  mucous  membrane,  to  contend  with. 
But  in  no  case  does  it  compare  in  exactness 
with  Method  A,  by  tongue  pressure. 

Bear  in  mind,  that  in  any  wa}^  the  cooling 
must  be  done  while  the  little  p)ressure  is  on. 


48  Greene  Brothers'  Cunicae  Course 

The  Essential  Art  in  Handling 
Modeling  Compound 

is  to  keep  it  cool  after  it  has  been  adjusted; 
and  to  warm  one  part  and  adjust  it  without 
disturbing  it  elsewhere.  But  the  work  is  no 
more  difficult  than  many  other  things  a  dentist 
has  to  do. 

While  it  requires  far  more  skill  to  take  a 
modelings  compound  impression  rightly  than  one 
in  all=plaster,  the  results  amply  pay  for  it,  and 
miany  times  over. 

In  the  details  of  a  single  impression  we  do 
several  different  things,  even  though  we  do 
them  all  at  once  in  combination. 

Now  every  one  of  these  details  can  be  done 
— at  least,  with  this  material  (Kerr's  'Terfec= 
tion)";  while  not  near  all  of  them  can  be  done 
with  plaster.  But  the  whole  plaster=  impression 
subject  is  to  come  up  later  on. 

Uniting  Details. 

In  actual  practice  we  unite  as  many  of  these 
details  as  the  case  will  warrant.  Sometimes  we 
can  very=edge  the  rim  all  around  at  once;  in 
large  mouths  with  thin  lips,  for  instance. 

And  then,  again,  as  already  shown,  we  can 
sometimes  conform  all  around  at  once,  even  in- 
cluding tuberosities. 

And  frequently  we  can  both  very = edge  and 
conform  all  at  the  same  step — perhaps  not  al- 
ways perfectly,  but  yet  to  stand  the  tests  fairly 
well. 

Sometimes — in  fact,  often — we  conform  be- 
hind tuberosities  and  post=dam  at  the  back  pal- 
ate at  the  same  time.  It  's  a  quick  and  easy 
way. 

Sometimes  the  center  can  be  equalized  with 
hot=stream  (seldom  necessar}^)  and  wave=press- 
ure  at  the  same  step  when  the  very=edging  is 


IN  Dental  Prosthesis.  49 

done.  And  it  's  possible  for  an  expert  to  do 
all  these  things  thoroughly  by  two  trips  into 
the  mouth;    and  fairly  well  by  a  single  trip. 

But  trips  into  the  mouth  don't  mean  by 
the  Greene  methods  what  they  do  by  the  old 
wa3^s,  by  any  means.  Our  metal  trays  are  not 
as  deep  nor  as  long  as  our  finished  plates  are 
to  be,  as  you  have  seen.  And  our  impressions, 
even  from  the  first,  contain  so  little  bulk  that 
patients  are  always  agreeably  surprised,  after 
having  heard  so  much  about  the  horrors  of 
impression=taking;  and  they  almost  invariably 
so  express  themselves— voluntarily,  too. 

And  for  this  one  reason  it  pays  to  use  the 
student's  method  of  fitting  a  tray  to  an  ap- 
proximate model  and  taking  the  correctable 
impression  from  this  model.      (Index  L.) 

Bear  in  mind,  we  use  no  common,  deep 
trays,  even  in  taking  an  approximate  impres- 
sion; and  seldom  one-fifth  as  much  material 
as  by  the  old  methods. 

Test  the  Completed  Impression. 

Now,  after  post  =  damiTiing  (Index  P),  we 
make  the  final  test.  AVe  slip  the  impression 
back  into  the  mouth  and  have  patient  open 
and  close,  laugh,  bite  her  finger,  and  swallow. 
If  none  of  these  movements  throws  the  impres- 
sion down,  they  '11  not  throw  down  a  plate  prop- 
erly made  from  it;  for  the  latter  will  be  a  mold- 
ed duplicate  from  the  foraier. 

Conversely,  if  any  movement  shotild  loosen 
the  impression,  it  would  do  the  same  to  the 
plate.  So  you  'd  know  one  or  the  other  in 
advance. 

Reall}^  you  '11  seldom  find  it  necessary  to 
make  any  correction  after  you  've  made  these 
six  steps  in  detail.  But,  for  convenience  of  il- 
lustration, we  '11  suppose  you  make  a  blunder 


50  Greene;  Brothers'  Clinical  Course 

in  your  first  attempt  at  a  test  impression.  Af- 
ter you  have  post=dammed,  3^ou  make  your  test. 
You  push  your  impression  up,  and  it  drops 
down,  even  without  an}^  lip,  or  cheek,  or  swal- 
lowing motion  at  all. 

Stop,  Think  and  Reason. 

After  you  got  the  length  of  the  impression 
and  then  tested  for  roof = fit,  you  found  it  stuck 
up.  After  you  muscle= trimmed  and  conformed 
its  rim,  it  stuck  still  tighter.  But  now,  after 
you  post=dammed  its  rear  end,  it  drops.  What  '5 
the  matter  f 

The  case  is  very  plain.  You  over= strained 
the  palate  in  post=damming.  The  over=strained 
parts  rebound  and  push  the  impression  off. 
What  's  the  remedy?  Common  sense — just 
ww=post=dam  it,  and  do  it  over. 

That  is,  warm  it  as  in  the  first  place,  and 
post=dam  again;  but  next  time  with  less  strain. 
Keep  on  till  you  get  a  stick=up  test. 

Don't  object  to  doing  this  three=minute  job 
over,  for  the  alternative  would  be  to  make  the 
plate  from  it  "over"— maybe  several  times. 
(Someone  says:    "We  're  used  to  that.'') 

Well,  you  've  re=post=dammed  and  have  a 
test;  but  only  a  5^7/ test.  It  stays  there  all  right 
when  no  muscles  move.  Now  give  it  another 
test.     Have  your  patient  swallow  vigorously. 

If  It  "Swallows  Down." 

My,  how  swallowing  throws  it  down !  What 's 
the  matter  now?  It  either  reaches  too  far  back 
or  else  some  small  palatal  muscle  (one  or  more) 
reaches  unusually  forward.  In  rare  cases  such 
may  reach  quite  a  way  forward. 

In  this  case,  370U  will  first  re = test  for  length. 
Maybe  you  missed  it  a  little  in  getting  proper 
length  in  Step  Two. 


IN"  Dental  Prosthesis.  51 

If  you  find  your  impression  isn't  too  long, 
then  try  for  palatal  muscular  strain.  That  is, 
warm  the  top  of  the  impression  at  the  very 
back  part,  place  it  in  the  mouth,  and  hold  to 
place,  while  patient  bites  on  your  finger  and 
swallows  vigorously.  She  can't  well  swallow 
without  biting  on  something. 

The  moving  muscle  will  strain  down  the 
softened  material;  and  thus  a  single  effort  ma^^ 
cure  the  trouble.  But  make  as  many  efforts 
as  are  necessary ;v  then,'  of  course,  re=post=dani 
slightly  and  cool  well  before  removal,  as  before. 

Take  Notice:  After  you  find  the  slight 
indentation  in  3'our  impression  made  by  the 
swallowing  test,  you  can  use  the  mouth  blow= 
pipe,  as  in  special  very=edging  for  muscle  room 
on  the  rim,  a  while  ago. 

About  Nausea. 

Never,  cut  off  a  plate  in  front  of  the  valve= 
pressure  line  to  prevent  nausea.  Even  if  it 
cured  the  "gagging,"  it  would  make  an  easy= 
tipping  plate.  But  shortening  alone  might  not 
cure  the  gagging. 

Nausea  is  often  caused  by  lack  of  pressure 
at  the  rear  of  the  plate.  Proper= fitting  (valve= 
pressure)  plates  can  be  worn  farther  back  than 
poori)^  fitting  shorter  ones  can  be. 

But  nausea  is  often  from  a  mental  delusion, 
and  then  must  be  cured  by  a  process  of  "nien- 
tal  suggestion."  If  a  patient  falsely  thotight  a 
bed=bug  was  under  her  dental  plate,  she  would 
"gag."  And  similarly,  if  she  thought  the  plate 
was  too  long  when  it  was  not  so. 

I  have,  as  others  have,  cured  scores  of  cases 
of  nausea  by  appropriate  means  of  suggestion. 
It  has  often  been  done  by  pretending  to  shorten 
the  plate,  "just  a  leetle  bit"  without  doing  so. 
And  all  experienced  dentists  will  tell  you  of 


52  Greene  Brothers'  Clinical  Course 


Fig.  4. 

Fig.  4.- — Modeling  compound  impression  as  usually  taken  in 
common  deep  tray.  Plate  would  have  to  be  guess-trimmed  to  lit 
straining  muscles — difficult  if  possible. 

Fig  5. — In  the  same  tray  cut  down  and  fitted  to  the  mouth. 
Test  impression  just  as  taken  by  the  Greene  muscle-trimming 
method.     No  trimming  of  plate  after  made. 


Modeling  compound  tested  impression,  just  as  taken;  for 
plumping  out  the  features.  Common  deep  tray  cut  down  for  the 
purpose. 


IN  Dental  Prosthesis.  53 

cases  where  they  cured  nausea  by  treating  the 
patient's  will-power.  Teach  them  how  to  ap- 
ply auto  =  suggestion.  (Every  dental  college 
should  be  supplied  with  a  "chair"  filled  with 
an  expert  instructor  in  Scientific  Suggestion.) 
When  the  cause  of  nausea  is  physical,  or 
material,  then  combine  physical  and  mental 
medicine.  Benumb  with  cocaine  and  "tan" 
with  oak=bark  tea,  or  an 3^  other  astringent. 
But  always  mix  in  good  Suggestion. 

Make  Model  on  Tested  Impression. 

Our  impression  now  stands  the  actual  test; 
w^e  must  "pour"  our  model  before  it  changes. 
Unless  w^e  can  fill  it  right  away,  we  must  keep 
it  in  cold  water  until  we  can  use  it.  Bear  in 
mind  that  even  this  ' '  Perfection ' '  material  will 
w^arp  some  in  a  warm  room.  So  impressions 
of  modeling  compound  must  be  kept  cool  until 
filled;  remember  that.  Better  underscore  this 
with  red  pencil. 

Before  we  pour  our  plaster,  w^e  '11  thin  our 
rim  dow^n  to  the  exact  thickness  we  want  our 
plate.  We  do  it  with  our  sharp  pocket=knife. 
If,  however,  we  want  the  patient's  face  built 
out,  we  leave  the  rim  thick,  or  even  add  to  it 
(carefully)  by  tracing=on  more  from  our  blessed 
tracing=sticks. 

Then,  also,  before  we  "pour,"  we  '11  polish 
the  rim=edge  by  quickly  passing  it  a  very  few 
times  over  our  little  spirit  flame  and  blowing 
onto  it  quickly  from  our  mouth.  But  be  care- 
ful not  to  heat  it,  in  the  least,  to  an}'  depth. 
Cool  between  each  blowing  and  don't  keep  it 
up  too  long. 

The  edge  is  now  polished,  and  ten  to  twent\ 
times  quicker  than  the  rim  of  the  plate  could 
have  been  polished  after  vulcanized.  The  com- 
ing plate's  rim  will  now  need  the  least  touch 
of  the  polishing^ wheel  to  complete  it. 


54  Greene  Brothers'  Ceinical  Course 

Again,  before  we  pour,  we  must  see  that 
our  impression  is  dry.  If  wet,  the  face  of  our 
model  may  come  out  soft,  from  lack  of  proper 
crystallization;  that  is,  from  too  much  water 
for  the  amount  of  plaster.  We  can  soap=lather 
our  impression  thinly,  or  dust  it  with  soap- 
stone  powder,  but  we  don't  wet  it.  It  must 
have  no  visible  water  in  it. 

I  know  this  is  contrary  to  high  authority, 
but  I  insist  on  no  water  in  my  impression  when 
I  make  a  model.  And  I  advise  you  to  make 
some  tests  along  this  line;  then  report  to  your 
old  instructors,  who  advised  wet  impression. 

Within  a  stretch  of  four  years,  I  asked  two 
hundred  and  fifty  dentists  what  made  their 
models  sometimes  come  out  of  the  impressions 
with  soft,  dusty  surfaces;  and  just  twelve  an- 
swered me  correctly  —  under  =  saturation  and 
faulty  crystallization. 

Of  course,  such  a  model  would  be  unfit  to 
vulcanize  on.  And  yet  how  many  plate=makers 
fail  to  comprehend  this  self=evident  fact! 

1  How  TO  Make  the  Model. 

Now,  mix  your  plaster  by  the  "  full=satura- 
tion"  method.  First  put  the  needed  amount 
of  water  in  a  clean,  smooth,  earthen  bowl  and 
then  put  the  plaster  in  it.  Don't  "sift  it  in 
slowly,"  for  some  of  it  would  be  wet  much 
longer  than  the  rest.  But  dump  it  in  hurriedly; 
then  hack  it  up=and=down  with  your  spatula 
till  it  is  wet  through.  Then  mix  quickly  and 
"pour"  before  it  begins  to  set  at  all.  Always 
tap  bowl  and  pour  off  all  the  water  you  can. 
Then  pepper=box  a  little  on  top  to  satisfy  the 
watery  surface,  if  needs  be. 

If  you  stir  it  after  it  begins  to  set  much, 
you  '11  violate  chemical  action,  break=up  the 
forming  crystals  and  make  an  imperfect  body; 


IN  Dental  Prosthesis.  .  55 

which,  though  hard  to  cut,  softens  readily  under 
heat  and  pressure.  So,  see  that  as  far  as  pos- 
sible all  crystallization  ("setting")  takes  place 
after  the  plaster  is  in  the  impression;  especially 
the  first  part  of  it. 

Extend  the  plaster  just  a  little  beyond  the 
rim  of  the  impression  all  around,  and  don't 
make  the  model  needlessly  thick  over  the  arch. 
Reason  for  this  later  on. 

Now,  after  the  plaster  in  the  impression  is 
well  set,  trim  it  (plaster)  off  all  around  down 
even  with  the  compound,  using  the  impression 
itself  as  the  guide  to  your  thin=ground,  sharp 
knife.  Hold  your  knife=blade  at  proper  angle 
so  as  not  to  cut  over  into  the  bench,  or  shoulder, 
of  th^  model;  ■  which  extension  is  to  form  the 
edge=rim  of  the  plate. 

To  Separate  Model  from  Impression. 

First  warm  the  metal  tray  and  pull  it  off. 
Then  set  the  impression  into  fairly  warm  water, 
just  deep  enough  to  cover  the  impression  ma- 
terial, and  not  to  warm  the  model. 

Then  turn  the  warmed  compound  down  at 
one  of  the  heel=comers  to  get  hold,  and  peel 
the  whole  impression  off  from  the  model. 

You  now  have  a  good,  hard=surfaced  model, 
with  a  smooth  bench;  which  extension  is  to 
give  the  plate  the  exact  same  height  and  thick- 
ness of  rim  the  impression  had.  Plaster  should 
be  "well  stirred,"  but  the  least  bit,  if  any  at 
all,  after  it  begins  to  set. 

As  for  myself,  /  like  to  polish  the  roof  of 
my  impression,  same  as  the  rim,  so  that  part 
of  my  plate,  too,  will  be  smooth  and  easily 
kept  clean  in  wearing.  But  should  yoii  do  this, 
be  sure  and  test  for  fit  again  before  you  pour 
your  model.  At  first  3^ou  '11  be  stire  to  use  too 
much  heat  in  polishing  your  impression;     for 


56  Greene  Brothers'  Ceinical  Course 

any  heat  is  too  much.  And  you  '11  be  apt  to 
continue  the  gloss=warming  and  blowing  too 
long. 

Don't  Let  Impressions  Change. 

Make  your  model  at  once,  before  the  impres- 
sion warps  from,  the  heat  of  your  room.  Or  else 
put  it  in  cold  water,  and  keep  it  in  until  you 
get  time  to  use  it.  Doctors,  this  repetition 
needs  no  apology.  You  've  probably  been  let- 
ting impressions  change  before  filling. 

The  absolute  unreliability  of  the  average 
' '  brand ' '  of  modeling  compound  in  holding  its 
shape,  and  the  ignorance  concerning  its  man- 
ipulation, and  the  carelessness  of  dentists  are 
the  principal  three  reasons  why  compound  is 
not  in  universal  use  for  impression=taking;  es- 
pecially for  full  plates. 

Metal  vs.  Plaster  Models. 

Now  as  to  the  question  of  models.  I  've 
given  you  what  I  conceive  to  be  the  best  meth- 
od of  making  plaster  models;  that  is,  full  sat- 
uration, with  no  stirring  after  hardening  begins; 
the  same  holding  true  of  the  various  mixtures 
of  plaster,  sand,  Portland  cement,  etc.,  etc. 

If  you  use  good  plaster  and  this  carefulness 
in  mixing,  and  don't  spoil  your  models,  nor 
pack  so  as  to  strain  them  any  after  they  be- 
gin to  soften  (by  natural  disintegration,  that 
takes  place  under  heat  and  moisture  at  about 
300  degrees  F.),  you  may  get  through  your 
case  without  much  change  in  your  model. 

But  under  the  greatest  skill  in  mixing  and 
pouring  and  flasking  you  will  always  have  some 
change;  possibly,  however,  in  a  direction  to  do 
more  good  than  harm,  as  to  that. 

Under  conditions,  plaster  will  expand  and 
contract;  and  its  compressibility  is  sometimes 
astonishing. 


IN  Dental  Prosthesis.  57 

To  prove  this  yourself,  make  you  two  plas- 
ter models  from  the  same  impression.  Then 
vulcanize  on  one  of  them  and  try  your  plate 
on  the  other  one.  There  will  alwa3^s  be  some 
lack  of  fit,  which  shows  just  what  change  took 
place  in  theTmodel  you  vulcanized  on  under 
moisture,  heat,  and  pressure,  including  the  force 
of  vulcanite  shrinkage  by  hurried  cooling. 

So  the  less  pressure  you  apply  in  packing 
(especially  after  your  model  begins  to  soften) 
and  the  more  slowly  you  cool  a  flask,  the  safer 
you  are  from  serious  change. 

And  now,  to  fuU}^  impress  you  with  the  com- 
pressibilit}^  of  plaster,  you  can  easily  make  a 
convincing  test  for  yourselves.  Prepare  a  flask, 
both  halves  fllled  with  the  best  plaster;  place 
a  silver  dollar  between  the  two  halves  and  boil, 
and  sc^ueeze,  and  vulcanize  as  usual.  Then 
open  it;  you  '11  find  your  silver  dollar  entirely 
hidden  in  the  plaster.  Then  use  two  dollars, 
one  on  the  other,  and  record  your  impromptu 
ejaculations.  (I  made  this  exposure  of  the 
faultiness  of  plaster  at  the  National  meeting 
at  Birmingham  in  1909.) 

Greene's  Non=Changeable  Model  System. 

But  I  'm  glad  to  report  to  the  dental  pro- 
fession that,  after  years  of  puzzling  over  the 
vexatious  question,  I  have  at  last  solved  the 
problem.  The  problem  of  avoiding  this  inev- 
itable change  in  plaster  models,  both  before 
and  during  the  flasking  and  vulcanizing  process 
and  in  hurried  cooling. 

I  do  it  by  disposing  of  95  per  cent  of  the 
amount  of  plaster  in  a  model,  to  begin  with; 
and  then  holding  the  5  per  cent  into  place 
so  the  infinitesimal  change  in  it  can't  do  any 
perceptible  haiTQ. 

I  iTiake  an  approximate  model  of  aluminum 


58  Greene  Brothers'  Cunical  Course 

with  its  surface  prepared  to  retain  a  thin  film 
of  plaster. 

This  aluminum  model  is  of  a  size  and  shape 
to  slip  down  into  and  approximately  fit,  but 
still  ver}^  loosely  fit,  the  impression.  In  fitting 
this  non= changeable  metal  model  to  the  impres- 
sion, I  first  besmear  its  face=surface  with  a  little 
plaster;  then  dip=pour  some  into  the  impres- 
sion and  plunge  the  face= covered  metal  model 
into  it;  then  hurry  up  and  complete,  the  same 
as  if  the  model  were  all  plaster. 

I  then  trim  the  model  while  yet  in  the  im- 
pression; and  also  remove  the  impression  ma- 
terial from  it — both  just  the  same  as  with  the 
all=plaster  one  before  mentioned. 

Now  we  haA^e  a  metal  model,  thinly  ve- 
neered with  plaster;  which  facing  is  necessary 
to  fit  it  to  the  impression,  and  also  to  enable 
the  removal  of  the  metal  model  from  the  vul- 
canized plate.  But  the  amount  of  plaster  used 
is  too  small  for  any  proportionate  change  in  it 
to  be  noticeable. 

I  may  here  add  that  in  some  cases  of  under= 
cuts  in  the  mouth  the  case  must  be  left  in  the 
flask  till  the  softening  takes  place  in  the  plas- 
ter coating  on  the  metal  model.  Leave  the 
case  in  flask,  if  convenient,  over  night;  in  fact, 
that  's  the  right  thing  to  do  in  vulcanite  work 
anyhow. 

But,  instead  of  making  an  approximate  mod- 
el for  each  case,  I  have  a  set  of  them  already 
made,  from  which  I  select  the  one  needed.  It 
consists  of  one  hundred  models  and  is  expected 
to  accommodate  almost  any  case,  full  or  partial. 

The  set  is  so  systematized  in  size,  shape, 
number,  and  letters  that  one  or  two  minutes 
is  sufficient  time  for  making  the  selection. 

For  swaging  (by  the  new=process  methods 
only),  we  veneer  our  metal  model  with  a  half= 


IN  Dental  Prosthesis.  59 

and=half  mixture  of  Portland  cement  and  plas- 
ter, well  pulverized  together  in  a  mortar  before 
wetting.  This  swage  =  model  must  thoroughly 
harden  before  use. 

(Here  the  class  is  shown  how  to  fit  Greene's 
non= changeable,  approximate  metal  models  to 
an  impression.  See  especial  instruction  in  Ap- 
pendix hereto.) 

modeling=compound  impressions  in 
Difficult  Cases. 

Our  instructions  so  far  apply  to  ordinary 
cases.  But  occasionally  we  find  mouths  where 
other  different  means  must  be  used.  For  in- 
stance, here  we  have  a  case  with  protruding 
ridge  in  front   and  an   "under=cut"   above  it. 

To  take  this  impression  and  preserve  the 
under=cut,  we  first  take  it  full}''  up  to  the  be- 
ginning of  the  turn  that  makes  the  under=cut. 
Then  we  trim  this  edge  of  the  impression  down 
so  as  to  dispose  of  all  of  the  under=cut. 

Now  cut  two  or  three  little  notches  in  the 
trimmed=off  edge.  Then  varnish  this  edge  and 
brush  a  thickness  of  tin=foil  onto  it.  The  var- 
nish is  to  hold  the  tin=foil  onto  the  trimmed 
edge  of  the  impression. 

Now  we  use  the  "Perfection"  tracing=sticks 
and  trace=on  enough  material  to  bring  the  rim 
up  to  its  proper  height.  Then  warm  the  traced= 
on  addition  over  the  spiritdamp  and  quickly 
slip  the  impression  into  the  mouth,  and  very= 
edge  and  conform  this  addition  down  onto  the 
main  part  just  as  if  the  two  were  all  one  piece. 
Then  cool  well  and  remove. 

In  taking  it  out  of  the  mouth,  the  addition 
will  pull  loose  from  the  main  body  of  the  rim, 
and  the  impression  come  out  in  two  pieces. 

Then,  when  out  of  the  mouth,  we  place  the 
addition  back  onto  the  impression  where  it  be- 


60  GRJif;Ni?,  Brothers'  Clinical  Coursl 

longs,  guided  by  the  notches,  and  we  have  our 
full  impression,  under=cut  and  all. 

Should  you  wish  to  take  an  impression  some- 
what over  a  bulging  tuberosity,  you  can  use 
plaster  for  the  addition,  if  not  too  thinly  mixed. 

Of  course  you  understand  the  tin=foil  is  used 
merely  as  a  separator  between  the  impression 
and  the  added  edge  over  it. 

If  you  take  more  of  the  under=cut  than  you 
can  use,  of  course  37'ou  '11  have  to  tip  the  plate 
accordingly  to  enter  it  over  the  bulge.  Prac- 
tically, it  's  no  use  to  take  more  of  an  under= 
cut  than  can  be  comfortabh^  used. 

Soft,  Flabby  Alveolar  Ridge 
WITH  Hard  Roof. 

Such  is  about  the  worst  case  you  '11  ever 
have  to  deal  with.  The  ridge  hangs  down  loose- 
ly and  flips  to  and  fro  as  your  lip  does  when 
you  talk. 

The  right  thing  to  do  is  to  absorb  this  flabby 
tissue  off,  and  reach  a  harder  density. 

This  can  be  done,  if  patient  can  be  controlled, 
with  perseverance  and  patience.  I  have  had 
usually  good  results  from  quarter= strength  iodine, 
with,  say,  two  per  cent  of  it  carbolic  acid. 

It  is  applied  on  bibulous  paper  worn  on  a 
temporary  plate.  One  of  shellac  base=plate  will 
generally  do. 

In  connection  with  the  medicine,  liberal  fric- 
tion should  be  applied  several  times  a  day, 
preferably  with  dry  woolen  cloth.  The  iodine, 
the  friction,  and  the  pressure  together  should 
complete  absorption  in  two  or  three  months. 

But  I  '11  give  you  two  recipes  that  are  prob- 
ably better;  or,  at  least,  quicker.  They  were 
given  me  personally  by  my  esteemed  friend, 
the  world=known  orthodontist,  Dr.  E.  A.  Bogue, 
of  I^ew  York  city— 63  W.  ^8th  Street. 


IN  Dental  Prosthesis.  61 

"Recipe  No.  i. 
"  Vienna  Paste  for  Reducing  Soft  Gums. 
[Translated.] 

"Caustic  Potash,  50  grammes. 

"Quicklime,  60  grammes. 

"Pulverize  the  two  substances  in  a  heated 
mortar;  mix  them  rapidly  and  thoroughly,  and 
put  them  into  a  wide  =  mouthed  bottle  with 
ground  glass =stopper. 

"We  make  a  soft  paste,  dissolve  with  a  lit- 
tle alcohol  and  apply  in  the  same  way  as  caustic 
potash. 

' '  Leave  the  caustic  twent}^  minutes  or  more 
in  place,  if  a  small  quantity  of  the  paste  has 
been  used  to  make  a  deep  opening.  Wash  the 
eschar  with  acidulated  water  to  neutralize  the 
remnants  of  the  caustic. 

"To  lessen  the  pain  caused  by  Vienna  Paste, 
Dr.  Piedagnel  added  a  quarter  of  a  gramme  of 
hydrochlorate  of  morphine, 

"To  make  sure  of  the  action  of  Vienna  Paste. 
Dr.  Dannecy  dissolved  the  potash  and  lime  in 
an  iron  spoon. 

"Vienna  Paste  melted  in  a  spoon,  or  poured 
into  a  leaden  cylinder,  is  a  caustic  which  destroys 
quickly  and  deeply." 

"Recipe  No.  2. 

"Dr.  Sass's  Formula  for  Reducing  Soft  G 11  jus. 

"iodide  of  zinc. 

"Zinc  Sulphate,  as  much  as  will  dissolve  in 
cold  water. 

"Dissolve  one  ounce  Iodide  Potash  in  two 
ounces  water,  and  add  as  much  Iodine  in  cr\'s- 
tals  as  it  will  take  up. 

"Then  take  equal  parts  of  above  solution 
and  put  them  together." 


62  Gre;e:ne  Brothers'  Clinical  Course 

I  've  known  dentists  heroically  to  use  a  pair 
of  curved  scissors.  But  here  in  this  lesson  we  '11 
go  on  and  do  the  best  we  can  without  removal 
of  tissues.  We  '11  compress  it  to  a  degree  of 
equalization  of  stress  between  it  and  the  hard 
roof.  We  '11  just  take  the  impression  as  here- 
tofore shown  in  a  plain,  easy  case". 

Of  course,  the  flabby  tissue  turns  outward, 
as  our  lip  does  when  we  push  it  with  our  tongue ; 
but  we  '11  push  it  back  again.  The  metal  tray, 
in  such  cases,  must  be  qtiite  low,  so  as  not  to 
interfere  with  such  back=pushing. 

Now,  while  the  impression  is  still  soft,  we 
finger = push  onto  the  outer  rim  until  the  soft 
gum  tissue  behind  it  is  back  to  about  its  normal 
hanging;    then  chill  well  and  remove  it. 

Next  we  hot=stream  the  impression  from  our 
spout=cup  till  its  bottom  surface  (not  to  rim= 
top)  is  quite  soft;  and  re  =  take  with  wave= 
pressure. 

This  time  the  cooled  outer  rim  of  impres- 
sion, being  hard,  prevents  the  flabby  flesh  from 
turning  outward  as  it  did  before. 

Our  upward  wave=motion  strains  the  mushy 
flesh  and  causes  it  to  compress  and  consolidate 
onto  itself;    that  is,  becomes  more  dense. 

We  repeat  this  several  times  if  necessary, 
until  we  get  the  flabby  tissue  almost  to  a  strain- 
ing or  rebounding  density;  that  is,  till  the  im- 
pression fits  the  soft  ridge  and  harder  roof  with 
approximate'  equality  of  stress — ^not  what  we  'd 
wish,  yet  approximately  so. 

Next  we  warm  the  impression's  rim=edge, 
hold  it  up  close  and  very=edge,  as  instructed 
before,  in  muscle= trimming.     (Index  V.) 

Then  we  re=warm  rim  (outer  side)  from  metal 
tray  to  top,  return  to  the  mouth,  and  conform, 
according  to  instructions  for  conforming  here= 
before  given.     (Index  C.) 


IN  Dental  Prosthesis.  63 

I'  And  lastly  we  '11  determine  the  length  rear- 
ward, and  post=darQ  according  to  density  of  back 
palate,  as  you  've"been  carefully  shown. 

And  now  for  test  for  ' '  sticktion . ' '  We  ought 
to  have  an  impression  that  will  not  readily  be 
thrown  down.  It  ma}^  rock,  if  pressed  on  in 
front  or  on  sides,  but,  while  it  gives  upward  on 
one  side,  it  gives  downward  oppositely.  Our 
valve=pressure=fit  all  around  saves  it  from  tip- 
ping entirely  loose. 

While  such  a  fit  isn't  fully  satisfactory,  a 
plate  from  it  can  be  worn  with  considerable 
comfort  and  practical  utility.  This  -  depends 
much  on  the  persistency  of  the  wearer.  I  've 
known  several  plates  to  rock  an  eighth  of  an 
inch  and  yet  worn  with  satisfaction.  I  mean 
in  these  cases  of  flabby  ridges.  The  "play"  of 
the  valve=pressure  kept  them  from  leaking  and 
tipping  loose. 

Flabby  in  Front  and  Hard 
ON  THE  Sides. 

Another  case  of  flabb}'  gum  is,  say,  where 
the  tissue  in  front  is  soft,  while  the  side  ridges 
are  hard.  In  this  case,  we  take  our  correctable 
impression  as  if  it  were  flabby  all  around.  This 
turns  the  soft  gum  outward.  Then,  while  the 
compound  is  still  soft,  push  it  back  (in  front) 
until  the  soft  ridge  is  to  its  normal  perpendicular 
position;   and  cool  before  removal. 

Then  take  it  (impression)  out  and  use  the 
hot=stream  once  or  twice  all  over  the  inner  sur- 
face, each  time  re=fitting  it  to  the  mouth. 

Sometimes  in  equalizing,  in  these  local  spon- 
gy  cases,  it  will  be  necessary  to  soften  only  the 
impression  over  the  hard  tissues,  in  order  that 
these  rigid  parts  may  cut  down  into  the  soft- 
ened material,  while  the  soft  tissues  are  being 
pressed  up  by  that  part  of  the  compound  that 
is  not  soft. 


64  Greenk  Brothers'  Clinical  Course 

To  heat  one  part  of  the  impression  and  not 
the  other  part  is  very  simple:  Just  pack  cot- 
ton over  the  part  not  to  be  heated,  before  pour- 
ing the  hot=stream;  then  immediately  remove 
it  before  re=taking  for  equalization. 

Thus  the  bony  ridge  cuts  into  the  softened 
impression  and  causes  the  hard  part  of  it  (im- 
pression) to  correspondingl}'^  push  up  and  dis- 
place the  soft  flesh,  to  equalization  of  pressure. 

To  recapitulate :  the  process  is  the  same  as 
we  had  a  while  ago  with  the  case  of  soft,  flabby 
ridge  all  around.  The  idea  is  to  hold  the  loose 
tissues  in  their  normal  position;  then  compress 
and  consolidate  them,  so  as  not  to  yield  much 
when  bitten  on,  and  to  rebound  and  keep  their 
room  filled  air=tight  when  not  under  strain. 

Study  such  cases,  and  study  your  patient, 
and  decide  whether  you  want  to  remove  the 
flabby  tissues  or  equalize  them",  and  then  act 
accordingly. 

A  Valuable  Review. 

(Here  the  whole  matter  of  equalizing  the 
soft  tissue  with  firm  ones  was  repeated  in  clinic 
till  the  class  could  explain  themselves.  Also  a 
review  was  made  and  the  class  re=impressed 
with  the  importance  of  conforming  and  post= 
damming,  to  the  purpose  that  plates  may  not 
tip  down  behind  while  bitten  on  in  front,  or 
tip  down  on  one  side  while  biting  on  the  op- 
posite side.) 

Roofless  Plates. 

By  a  roofless  plate  we  mean  one  whose  roof= 
center  is  lacking.  It  is  a  fact  that  fully  one= 
half  of  all  upper  cases  might  be  made  roofless. 
Indeed,  many  more  could  be  if  we  had  not  mal= 
educated  the  public  to  the  idea  that  dentures 
should  stick  tightly  in  the  mouth. 

I    say   "mal=educated,"   because   from   long 


IN  Dental  Prosthesis.  65 

observation  and  personal  experience  I  'ni  con- 
vinced of  the  fallacy.  It  's  not  the  tighUsticking 
plate  we  need,  but  the  one  that  can  be  worn 
more  loosely  and  more  comfortably  without  be- 
ing thrown  down,   or  up,   by  straining  tissues. 

It  is  a  truth  (surprising  to  some  non=think- 
ing  dentists)  that  cases  are  numerous  where  a 
roof  covering  the  entire  palate  is  detrimental  to 
retention  of  the  plate,  as  well  as  to  the  comfort 
of  the  wearer. 

A  toothless  upper  jaw  with  a  very  hard  cen- 
ter is  frequently  one  of  them.  Especially  is 
this  so  if,  as  is  generally  the  case,  the  rear  of 
the  plate  doesn't  reach  back  beyond  the  hard 
part,  and  doesn't  fit  up  on  the  soft  so  as  to 
make  valve=like  pressure. 

I  mean,  to  plainly  put  it:  if  a  plate  is  cut 
off  too  short  on  a  hard=roofed  mouth,  it  'd  bet- 
ter be  cut  clear  out,  up  to  the  ruga  or  even 
beyond.  In  that  case,  the  plate  would  settle 
as  the  ridge  absorbed  and  the  fit  would  still  be 
maintained. 

It  is  sometimes  funny  to  see  dentists  bug 
out  their  eyes  at  the  mention  of  a  roofless  jull 
denture  when  they  are  already  making  roofless 
partials,  more  difficult  than  the  others. 

But,  to  make  a  roofless  full  plate  practica- 
ble, its  rim  must  reach  the  proper  height  all 
around,  including  tuberosities,  and  have  a  good, 
close  valve=fit  on  the  inner  edge  thereof. 

This  is  done  by  muscle = trimming  for  height 
and  conforming  for  pressure,  as  3'^ou  've  been 
shown  in  other  cases. 

Then  it  must  also  have  the  same  sort  of  a 
fit  on  the  lingual  inner  edge.  Hence  the  plate 
mustn't  be  trimmed  off  quite  to  the  hard  bor- 
der of  the  ridge,  for  there  we  can't  make  the 
necessary  valve=pressure  to  prevent  its  tipping. 

It  should  extend  down  to  where  the  mouth 


66  GreiJne;  BR0TnE;Rs'  Cunical  Course; 

is  a  little  soft.  And  then,  instead  of  post=dani- 
ming,  we  side=press  the  edges  with  firm  tongue 
pressure;    in  some  cases,  with  finger  pressure. 

Don't  attempt  to  get  the  "extra  pressure" 
by  scr.aping  the  model,  for  there  may  be  vari- 
ous densities  of  the  half=soft  tissues.  Scraping 
is  guess=work  at  best;  and  you  can't  test  it. 
When  side=pressed  with  tongue,  or  even  finger, 
we  can  test  for  satisfaction  of  fit.  And  again 
here  I  repeat  without  apology:  All  conforming 
must  be  done  by  cooling  the  material  while  'it  still 
presses  the  yielding  tissues. 

While  an  impression  for  a  roofless  plate  is 
taken,  in  a  general  way,  the  same  as  for  a  roof 
plate,  especial  care  should  be  made  in  every 
step  and  detail. 

The  rim  and  heel  trimming  (very=edging) 
must  dispose  of  all  muscle  strain,  and  yet  in  a 
way  to  leave  no  leak.     "Relief  without  leak." 

Take  notice:  When  I  say  you  can't  cut  a 
plate  off  where  it  edges  on  a  hard  part,  I  mean 
from  the  middle  of  the  mouth  rearward.  It 
may  rest  on  such  places  forward  of  the  center 
without  harm;  for  the  more  pressure  there,  the 
tighter  it  fits. 

^  But  I  repeat:  When  you  have  a  very  hard 
place,  better  cover  model  there  with  tin=foil, 
when  packing,  to  provide  for  the  inevitable  set- 
tling of  the  soft  parts  in  adjustment,  by  wear- 
ing. The  softer  the  soft  parts,  the  thicker  the 
tin=foil  should  be.' 

Instruction  to  Patients. 

When  you  make  a  roofless  plate,  be  sure 
to  instruct  your  patient  to  practice  chewing 
chipped  ham  or  dried  beef  on  both  sides  at  once, 
between  meals,  for  a  week  or  two,  to  evenly 
adjust  plate,  all  around  alike.  This  can  be  done 
also  by  a  habit  of  biting  the  teeth  together 


TN  Dental  Prosthesis.  67 

without  food,  if  the  occlusion  is  good.  Instruct 
her  to  do  both. 

Well,  in  fact,  this  should  be  the  instruction 
in  all  cases  of  artificial  teeth  on  plates.  It  is 
best,  generally,  for  patients  not  to  try  eating 
at  table  until  they  have  practiced  on  simple 
food,  on  both  sides  at  once,  and  feel  the  need  of 
their  teeth  at  meal=time. 

When  they  can  do  a  little  better  with  the 
teeth  than  without  them,  all  is  safe — "the  Ru- 
bicon crossed,"  But  don't  over=do  the  sug- 
gestion of  "perfect  satisfaction"  unduly  soon. 

Much  experience  induces  me  to  insist  on 
this  advice  to  dentists — learning  at  first  on  both 
sides  at  once.  And  they  '11  always  gratefully 
remember  me  for  it,  too. 

Extra  Support  to  Roofless  Plates. 

When  you  make  a  roofless  rubber  or  cellu- 
loid plate,  strengthen  it  across  the  front  pal- 
atal surface  with  perforated  gold  or  other  metal 
plating. 

To  do  this,  you  first  fit  }^our  metal  support 
to  the  model  approximately;  then,  in  packing, 
first  lay  down  a  thin  sheet  of  vulcanite;  then 
the  perforated  plate  onto  this  rubber;  and, 
lastly,   another  vulcanite  sheet  on  the  metal. 

But  this  instruction  belongs  to  our  last  les- 
son of  this  Course. 

Retention  of  Roofless  Plates. 

Roofless  full  plates  will  not  generally  stick 
up  as  tightly  in  the  mouth  as  others,  provided 
the  full  roof  ones  fit  just  right,  and  that  right  fit 
contimies.  But  the}^  stay  quite  well  enough  if 
fitted  properly  and  persistently  worn  to  easy 
adjustment. 

In  furnishing  roofless  plates,  use  careful  judg- 
ment as  to  "indications"  of  the  mouth  and  as 


68  Grkenk  Brothers'  Clinical  Course 

to  the  good  sense  of  your  patient.  Good  ridges 
with  prominent  heels  indicate  roofless  plates; 
and  real  desire  for  them  indicates  the  wearer. 

Few  people  having  worn  roofless  plates  would 
be  content  with  any  other.  A  roof  does  inter- 
fere with  taste  to  some  extent;  and,  if  in  no 
other  way,  by  obtunding  the  sensitive  nerves 
of  the  tongue  by  frictional  contact,  the  same 
as  work  with  a  hoe  handle  will  "harden"  the 
fingers  and  hands,  so  a  blind  person  can't  well 
read  raised  letters. 

Though  I  formerly  argued,  in  the  fashion, 
otherwise,  I  now  "know  for  myself,  and  not 
for  another,"  better. 

Don't  hobby=ride  roofless  plates,  but  make 
them  unhesitatingly  when  a  roof  would  be  det- 
rimental or  unpleasant.  Then  get  a  fair  price 
for  'em.  This  3'ou  can  easily  do  Avith  a  reputa- 
tion for  making  them. 

Partial  Upper  Impression. 

Novv"  we  come  to  the  easiest  of  all  impres- 
sions— partial  upper  cases. 

Cut  your  tray  low,  so  the  material  won't 
run  up  much  onto  the  natural  teeth.  If  it  runs 
high,  you  may  not  know  whether  the  over=lap 
holds  the  impression  tight  or  whether  it  's  the 
suction  to  the  roof  that  does  it,  in  your  test. 

Trim  your  trav  also  a  bit  shorter  behind 
than  you  want  your  finished  plate,  so  3^ou  can 
later  on  post=dam  impression  with  tongue  press- 
ure or  otherwise.     (Index  L.) 

Now  be  dead  sure  A^our  tra}^  and  material 
can't  part  company.  Better  have  some  small 
holes  through  the  tray,  in  addition  to  the  melted= 
on,  stick  =  tight  lining  heretofore  shown.  (In- 
dex S.) 

Pile  your  water=warmed  compound  high  up 
m  the  center  and  well  forward,  and  lastlv  warm 


IN  Dental  Prosthesis.  69 

well^'over  spirit  flame;  then  take  as  shown  for 
full  mouth.  Cool  thoroughly  with  sponge  held 
on  under  side,  as  shown  before,  and  remove 
with  caution. 

Then  get  length  (Index  L)  and  post=dam 
(Index  P)  as  in  full  case.  In  partials  you  con- 
form only  when  usual  adjacent  teeth  are  miss- 
ing. Mind,  now,  we  're  talking  about  partials. 
But,  mark  a^ou,  we  've  had  only  a  simple,  easy 
case,  where  there  w^ere  no  leaning  teeth  nor 
bell=shaped  crowrs  to  interfere  w^th  removal 
of  impression.  "There  are  others."  (Class  re- 
sponds:    "Yes,  there  are  others!") 

Leaning  Teeth  and  Bell=Shaped  Crowns. 

In  cases  of,  leaning  teeth  and  bell-shaped 
crowns,  }-ou  '11  first  use  some  of  the  "Perfec- 
tion" material  to  build  around  and  core  them 
out,  cone=like=shaped  at  all  points.  Then  var- 
nish the  coring  and  cover  quickly  with  tin=foil. 
The  varnish  is  to  hold  the  foil,  while  the  latter 
s  a  separator  between  cores  and  impression. 

But,  before  you  stick=on  the  foil,  cut  a  few 
sharp  notches  in  the  corirg,  after  it  is  adjusted 
around  the  teeth. 

Now^  treat  your  cored=out  teeth  as  if  they 
were  fully  real  ones;  and  go  on  and  take  the 
impression  accordingly. 

Cool  your  impression  w^ell  before  taking  it 
out  of  the  mouth.  Take  it  out;  the  coring 
will  remain  in  place  around  the  natural  teeth. 
Then  chill  cores  in  place  w^ith  cold  water  thor- 
oughly. Split  them  in  sections  lengthwise  wdth 
the  teeth,  then  remove  the  pieces  carefully  with 
pliers  and  place  them  home  in  the  impression. 

This  "Perfection"  material  breaks  satisfac 
torily  when  cold.     The  cold  water  may  be  ap- 
plied with  syringe,  cotton,  or  bibulous  paper. 


70  Greene  Brothers'  CivInicae  Course 

Recapitulation  on  Coring. 

In  cases  of  leaning  teeth  and  bell=shaped 
crowns,  we  take  sectional  impression;  then  join 
the  parts  and  make  our  model.  If  a  plaster 
model,  we  sometimes  strengthen  it  with  wire 
and  pins.     But  better  use  metal  models. 

Of  .course,  some  of  this  may  require  careful 
manipulation,  but  no  more  so  than  many  other 
operations  dentists  do  and  without  complaint. 

Plaster  Impressions  for  Partial  Plates. 

A  simple  wa}^  however,  for  accomplishing 
the  results  just  shown  is  to  first  take  the  im- 
pression in  modeling  compound  only  approxi- 
mately; then  complete  it  with  plaster. 

To  do  this  we  take  the  impression  and  work 
it  up=and=down,  as  it  cools,  slowly  in  the  mouth. 
After  taken  out,  we  find  it  has  "drawn"  and, 
of  course,  doesn't  fit.  It  loosely  slips  over  the 
leaning  and  bell=shaped  teeth,  as  expected. 

When  out  and  cooled,  we  cut  it' off  at  rear 
for  length  of  plate  (Index  L)  and  post=dam  it. 
Then  cut  away  the  modeling  compound  around 
next  to  the  teeth  sockets — next  to  the  teeth  that 
lean  or  are  bell= crowned.  This  to  make  room 
for  a  plaster  facing  on  the  compound,  say  of 
a  line  in  thickness;  that  is,  thick  enough  to 
break  without  crumbling. 

Now  we  '11  cover  our  approximate  impres- 
sion all  over  with  a  thin  layer  of  creamy =like, 
ready=flowing  plaster,  and  take  quickly,  with 
light  wave=pressure;  then  leave  it  in  the  mouth 
until  it  thoroughly  sets.  The  remnant  in  our 
bowl  will  tell  us  when  that  in  the  mouth  is  hard. 

Here  comes  the  "  tug=of =war  " !  Remove  it 
from  the  mouth,  oh,  so  slowly  and  carefully! 
The  plaster  will  hang  almost  air=tight  and  as 
if  glued  to  the  natural  teeth.  And  woe  if  the 
compound  hasn't  been  perfectly  secured  to  the 


IN  Dental  Prosthesis.  71 

metal  tra}"!  Of  course  you  '11  have  to  go  through 
a  few  educating  come=loose  scrapes  to  make  you 
careful. 

It  's  wiggle  and  pull,  and  pull  and  wiggle, 
harder  and  harder,  till  ''something  gives,"  even 
when  results  are  as  intended.  It  is  the  film 
of  plaster  that  has  pulled  loose  from  our  ap- 
proximate modeling= compound  impression.  The 
arrangement  was  made  for  just  this  intended 
breakingdoose ;   so  no  harm  done. 

We  push  the  loose  piece,  or  pieces,  of  plas- 
ter back  tightly  to  place  (with  thin  cement 
if  necessary),  and  now  have  a  perfect  plaster 
facing  to  the  entire  approximate  compound 
impression. 

Our  post'=damniing  has  forced  the  flowing 
plaster  to  equalize  the  m.outh's  inequalities. 
We  '11  dry  our  impression,  varnish  it,  and  make 
our  model;  same  as  in  case  of  full  mouth, 
plaster  or  metal. 

Bear  in  mind,  if  you  don't  post=dam,  you  '11 
probably  have  no  fit  at  rear  and  no  equalized 
roof  pressure.  Without  post=damming,  we  'd 
have  merel}^  an  old=fashioned,  hap=hazard  fit; 
because  if  the  plaster  can  escape  without  push- 
ing up  the  soft  parts,  it  will  do  so.  That  is, 
it  goes  where  it  meets  least  resistance.  Non= 
flowing  plaster  might  press  up  too  hard. 

Only  a  properly  post = dammed  rear  will  in- 
sure equal=pressure  plaster  fit  over  the  roof. 
But  this  correct  post=damming  can  be  known 
only  by  test.  If  too  strong,  the  tissues  would 
push  the  denture  down  behind.  And  that  's 
what  often  happens  when  using  a  metal  tray 
turned  up  too  high  behind. 

Still,  as  plates  made  by  the  old  methods 
oftener  fit  up  too  lightly  than  too  tighth'  be- 
hind, the  manufacturers  of  tuni=up=behind  trays 
have  that  one  mitigating  circumstance  as  an 
apology. 


72  Grfikni:  Brothers'  Clinical  Course 

To  Test  a  Plaster  Impression. 

To  test  for  the  correctness  of  an  old=fashioned 
plaster  impression,  just  trim  it,  after  taken,  ex- 
actly as  3^ou  want  your  finished  plate  to  be, 
length  and  all;  metal  tray  and  all.  Then  var- 
nish it,  and  soap  it  to  prevent  adhesion  (not 
suction),  and  return  it  to  the  mouth. 

Have  patient  make  the  usual  plate=wearing 
movements  generally  on  the  impression.  .  If  she 
can  laugh,  bite  down  on  her  finger  on  the  tray, 
and.  can  swallow  without  dislodgment,  she  could 
do  so  on  a  plate  made  from  it.  If  not,  then 
very  probably  not.  But  you  'd  know  one  or 
the  other  in  advance. 

But  you  'd  have  difficulty  in  so  trimming 
and  testing  an  "ancient,"  deep,  long  metal  tray. 
But  the  test  would  test  all  the  same. 

But  there  'd  be  further  trouble  with  your 
old  =  fashioned  plaster  impression.  After  you 
had  taken  and  tested  it  and  found  it  wanting, 
you  'd  have  a  whole  lot  of  trouble  to  correct  it. 

You  coiild  do  it,  in  a  way,  however,  by  our 
methods,  by  tracing=on  compound,  very=edging, 
confomiing,  post=damming  and  re=taking,  with 
flowing  plaster. 

But,  doctors,  just  stop  and  think  and  have 
a  laugh  over  the  fun  you  would  have  in  taking 
your  correctable  impression  in  plaster,  in  a  high, 
cheek=spreading,  long,  heav3^=metal  tray,  with 
a  regulation  long  handle. 

Plaster  Impressions  in  Modeling=     ' 
Compound  Trays. 

Many  \^ears  ago  the  elder  one  of  the  two 
Greene  Brothers  (the  late  Dr.  P.  T.,  of  New 
Albany,  Ind.)  originated  and  taught  for  years 
(as  a  secret)  the  now  common  method  of  tak- 
ing -first  an  approximate  impression  in  hee's^wax 
( in  later  years  substituting  modeling  compound) 


IN  Dental  Prosthesis.  73 

and  then  using  in  it  a  thin  layer  of  very  soft 
plaster  for  the  permanent  impression. 

It  importantly  amounted  to  having  a  better 
fitting  tray  than  could  be  made  of  metal,  and 
therefore  was  a  very  decided  improvement  over 
the  old  way  of  a  common  impression  in  a  non= 
fitting  tray. 

But  it  was  not  a  fully  complete  way,  nor 
a  full}"  correct  one.  It  didn't  give  the  exact 
height  nor  the  length  of  the  plate.  Nor  did 
it  always  give  a  valve=pressure  fit  up  behind, 
nor  around  the  heels,  nor  on  the  inner  side  of 
the  top  of  rim.  Nor  did  it  pretend  to  give  the 
fullness  of  the  lip  and  cheek  features. 

Plaster,  if  soft  enough  to  flow  to  the  difl'er- 
ent  parts  where  needed,  will  go  where  it  meets 
least  resistance;  hence  will  run  out  behind  with- 
out lifting  the  yieldable  tissues  up  to  the  es- 
sential valve=pressure  strain. 

But  no  better  proof  is  needed  to  show  up 
the  faultiness  of  plaster,  especially  in  a  non= 
fitting  metal  tray,  than  to  take  two  or  more 
impressions  from  the  same  mouth,  in  the  same 
way,  and  then  make  a  model  on  one  and  try 
it  in  the  others.  It  will  seldom,  if  ever,  fit  an- 
other impression  than  the  one  it  was  made  from ; 
nor  often  fit  any  two  very  nearly  alike.  Think 
of  the  chance  in  getting  them  alike! 

In  order  to  get  them  alike,-  you  'd  need  to 
have  two  metal  trays  alike,  mix  your  plaster 
each  time  alike,  and  give  the  same  pressure  at 
the  same  angles  each  time  alike.  This  is  a  math- 
ematical remoter  ess  next  to  an  impossibility. 

In  a  modelings  compound  impression  and  by 
our  system,  we  '11  not  ask  nor  care  whether  it  "s 
like  another  or  not.  We  don't  judge  an  im- 
pression by  its  looks. 

Our  system  is  one  of  absolute  test.  We 
simply  make  om"  that  will  stand  the  practical 


74  Greex£  Brothers'  Cu^^CAE  Course 

test,  and  be  sure  of  it.  And,  doctors,  this  can 
be  done  even  with  good  bee 's= wax  better  than 
with  ah  plaster. 

To  Take  Test  Impression  in  Plaster. 

To  ihustrate  the  principles  here,  I  may  have 
to  repeat  a  httle.  We  'h  go  back  and  take  uj) 
our  finished,  tested  impression  of  modehng  com  - 
pound.  Of  course,  that  'd  be  all  we  'd  need  in 
a  practical  case.  But  now,  sa3%  we  want  it  in 
plaster. 

If  it  is  air=tight  (which  it  proved  to  be  in 
the  test),  it  's  also  water=tight.  Now,  I  '11  pour 
in  a  half=teaspoonful  of  water  and  push  it  up 
to  place  at  similar  strain  as  when  tested.  Now, 
what  becomes  of  the  water f 

It  's  a  simple  proposition.  It  can't  pass  our 
conformed  rim  and  post=dammed  rear  =  parts 
without  strain  effort.  It  can  run  all  over  the 
surface  inside  more  easily  than  to  strain  through 
the  dammed= conformed  environment. 

It  will  do  more;  it  '11  even  exert  a  strain 
inside  equal  to  that  necessary  to  force  through 
its  marginal  hindrance.  So,  by  the  law  (of 
following  the  line  of  least  resistance),  it  must 
equalize  the  stress  on  all  parts  inside  with  that 
of  the  A'alve=pressed  margin,  before  it  can  es- 
cape. Nor  will  there  be  any  to  escape  unless 
there  is  more  than  necessary — a  surplus. 

Well,  now%  for  instance  and  for  illustration, 
we '11  command:  "Hokus=pokus,  presto  change!" 
And  our  confined  water  becomes  a  sheet  of  ice. 
Take  it  out  of  the  mouth,  and  we  see  a  film  of 
ice  that,  in  its  difference  of  thickness  at  dif- 
ferent places,  shows  just  what  the  impression 
lacked  of  exact  equahpressure  strain  before. 

If  the  ice  is  the  same  thickness  all  over, 
it  then  shows  the  strain  was  equal  all  over 
the  modeling  com.pound  before  the  water  was 
inserted. 


IN  Dental  Prosthesis.  75 

You  now  see  I  have  made  equal  strain  by 
hydraulic  pressure.  But  suppose  there  had  been 
some  holes  through  the  compound.  Would  the 
water  have  pressed  up  the  soft  parts  and  caused 
the  equal  strain  ?  Certainly  not.  It  would  have 
run  out  through  the  holes,  to  follow  the  way 
of  least  resistance.     That  is  all  very  plain. 

Now  let  us  play  the  same  game  with  this 
thin,  creamy,  easy= flowing  plaster.  It  will  not 
flow  quite  as  readily  as  the  water  did,  but  w^ell 
enough;  provided,  of  course,  the  same  condi- 
tions prevail  as  did  before. 

We  '11  take  the  same  impression  we  had  be- 
fore. We  '11  mix  some  quick=setting  plaster  to 
about  the  consistency  of  medium  cow's=cream 
and  pour  into  the  impression,  turning  this  way 
and  that  way  till  it  covers  all  the  compound 
up  to  within  about  an  eighth  of  an  inch  of  the 
top.  We  '11  hold  it  there  for  a  few  seconds  and 
sling  it  all  out  but  merely  enough  to  hide  the 
surface.  Then  with  the  blade  of  our  knife  or 
small  spatula  we  '11  trace=on  a  smidgen  from 
same  batch  along  the  roof  center  from  front  to 
rear.  Then  quickly  re=take  with  tremulous  mo- 
tion, at  normal  plate= wearing  pressure. 

In  this  re=taking  we  still  use  the  long  flex- 
ible middle  finger  of  our  right  hand,  of  course. 

If  our  thin=flowing  plaster  is  in  proper  con- 
dition, the  little  smidgen  of  excess  in  the  cen- 
ter will  wave = move  the  rest  all  over  the  sur- 
face to  perfect  equalization  of  pressure.  But 
bear  in  mind,  if  plaster  even  begins  to  set,  in 
the  least,  before  pressure  to  the  mouth,  there  '11 
probably  be  a  failure;  just  as  we  'd  have  had 
if  we  'd  have  waited  till  the  water  had  become 
mush  =  ice.  Now,  doctors,  are  you  fully  im- 
pressed that  a  read3^=flowing  condition  of  the 
plaster  is  essential  ? 

And  do  }'Ou  fully  understand  that  it  's  just 


76  Greene  Brothers'  Clinical  Course 

as  essential  for  perfect  equal  pressure  that  plas- 
ter must  be  confined — by  conforming  and  post= 
damming  ? 

Well,  anyhow,  let  me  clinch  your  under- 
standing and  memory  with  what  has  been  called 

"The  Pass=Word  for  the  Greene  Method 
OF  Plaster  Impressions.'.' 

''  Creamy=like  plaster;  in  ready=flowing  con- 
dition; confined;  normal  plate-wearing  pressure, 
with  ivave=niotion.'" 

If  rightly  done,  it  's  not  expected  there  '11 
be  any  excess  to  flow  out  behind,  nor  over  the 
rim;  but  should  there  be  a  little,  just  wipe  it 
off  outwardly,  after  taken,  and  use  the  com- 
pound edge  only  as  the  guide  for  model. 

If  an  impression  is  taken  in  this  way,  it 
will,  in  some  cases,  fit  technically  better  than 
the  ' '  modeling  =  compour  d  tray ' '  did  before ; 
but  seldom  practically  so.  For  it  stood  the 
test;  and  probably  quite  as  well  as  the  plaster 
addition. 

Then,  practically  it  makes  little  difference 
what  material  is  used,  just  so  all  parts  of  the 
impression  will  stand  requisite  tests.  iVnd  this 
should  include  the  fullness  of  the  lips  and  cheeks, 
too.  This  necessity  has  been  the  "mother  of 
our  new  invention" — the  tray  with  removable 
handle. 

To  test  a  "pass=word"  plaster  impression 
made  in  this  way,  you  '11  let  it  dry,  varnish 
it,  or  soap  it,  let  the  varnish  dry,  and  then 
soapstone=powder  it  before  the  test. 

If  it  doesn't  stand  the  test,  you  haven't  fol- 
lowed the  five  points  of  the  "pass=word."  You 
have  probably  gotten  your  plaster  too  thick,  or 
let  it  begin  to  set  before  using  it.  Watch  out 
especially  for  these  two  probable  troubles. 

I  hope  you  now  see  the  difference  between 


IN  Dental  Prosthesis.  77 

this  "pass=word"  perfect  way  of  taking  a  plas- 
ter impression  and  our  old  improvement,  first 
introduced  about  twent}^  years  ago;  which  was 
merely  taking  a  common  modeling= compound 
or  wax  impression  and  pouring  plaster  into  it, 
and  re=taking  it. 

My  first  " Eureka "= dance  over  an  "improve- 
ment in  plaster  impressions"  was  nearly  forty 
years  ago,  when  I  varnished  and  soaped  an  im- 
pression and  re=took  it  in  creamy,  soft  plaster. 
And  it  was,  indeed,  a  great  advance  step  at  the 
time.  It  has  since  been  known  as  a  "double 
plaster  impression." 

I  make  these  remarks  because  some  who 
have  gotten  onto  our  first,  long=ago=introduced 
improvement  jump  to  the  notion  that  they  "al- 
ready know"  our  present  perfect  pass=word  meth- 
od. Our  perfect  equalization  of  to-da)"  was 
only  hinted  at  in  our  old=time  improvements. 

Why  Plaster  at  All  for  Impressions? 

Some  one  of  the  class  always  asks:  "Why 
use  an}^  plaster  at  all,  after  your  compound  im- 
pression stands  the  test?"  Well,  really  no  use, 
in  full  cases.  And  I  show  you  this  "pass=word 
method"  mostly  to  expose  the  fallacies  of  plas- 
ter impressions,  taken  in  the  old  wa}',  with  the 
old,  ridiculous,  non=fitting,  mouth  =  stretching 
trays,  with  nauseating,  choking  surplus  inaterial. 

And  I  don't  think  you  '11  ever  take  many 
more  plaster  impressions  for  full  new  dentures, 
after  you  know  how  and  have  some  practice 
in  using  this  "Perfection"  compound  material. 
But  you  '11  frequently  use  the  "pass=word" 
equalizing  method  in  cases  of  upper  partials 
where  there  are  leaning  natural  teeth  or  bell= 
shaped  crowns;  also  in  refitting  and  renewing 
old  plates. 

In  taking  a  plaster  impression  by  the  pass= 


78  Greene  Brothers'  Clinical  Course 

word  wa}^  never  use  more  than  a  spoonful  of 
plaster.  If  careful,  none  of  it  escapes  to  "gag" 
or  disgust  the  patient, 

I  may  mention  here,  by  the  way,  that  if 
you,  from  the  first,  conclude  you  want  to  take 
a  pass=word  plaster  impression,  it  isn't  neces- 
sary that  the  compound  should  fit  the  roof  of 
the  mouth  exactly  —  excepting  at  the  post= 
dammed  rear;  for  the  five  conditions  of  the 
pass=word  will  force  a  fit  everywhere,  anyhow. 

We  make  a  model  in  a  thus  plaster=lined 
impression  the  same  as  in  a  compound  one,  ex- 
cepting that  in  the  plaster  we  use  varnish  as 
a  separator  instead  of  lather  or  powdered  soap- 
stone. 

And  lastly:  if  3^ou  use  the  Greene  ready= 
made,  non= changeable  models  in  any  sort  of 
plaster  impression,  you  fit  them  to  it  the  same 
as  to  one  of  model  compound. 

A  "Ouick=Step"  Denture. 

If  you  wish  to  make  a  plate  quickly  and  ask 
no  -better  one  than  you  'ye  been  making  of  vul- 
canite, but  still  want  to  kyiow  in  advance  how 
it  will  -jit,  I  '11  now  show  a^ou  how  you  can  do 
it  in  from  two=and=a=half  to  three  hours,  from 
start  to  finish. 

I  say  "no  better  than  you  've  been  mak- 
ing" because  you  've  probably  been  making 
plates  that  break;  when  a  properly  vulcanized 
plate  of  good  vulcanite  Avill  not  break. 

The  samples  sent  out  by  the  manufacturers 
will  not  break;   they  '11  bend  rather  than  break. 

But  the  matter  of  vulcanizing  will  come  up 
in  the  last  one  of  our  three  lessons — the  ' '  third 
degree." 

Supposing,  for  instance,  yoin-  case  is  a  full 
upper  one :     Fit  your  metal  tray  to  the  mouth — 


IN  Dental  Prosthesis. 


79 


for  quickness,  by  practitioner's  method.  (Index 
P.)  Then  soapstone  it,  §o  impression  will  readi- 
ly separate  from  it. 

Take  a  modeling= compound  impression  and 


Fig.  7-  i'lS-  ^• 

Two  Upper  Plaster  Impressions. 

Fig.  7. — Typical  old-style,  tissue-straining,  non-tested  plaster 
impression;  taken  in  average  deep  tray,  not  fitted  to  mouth.  A 
plate  made  from  it  would  have  to  be  guess-file-trimmed  to  fit  mov- 
ing muscles — next  thing  to  impossibility. 

Fig.  8. — Plaster  tested  impression,  "pass-word"  method. 
("Creamy-like  plaster;  in  ready-flowing  condition ;  confined;  nor- 
mal plate-wearing  pressure;  with  wave  motion.")  Modeling  com- 
pound edge-rim  accurately  muscle-trimmed.  No  trimming  of  plate 
after  made. 

test  it,  as  I  've  shown  you.  Then  tap  it  out 
of  the  tra}'  and  cool  it  still  more  than  3'ou  did 
in  the  mouth. 

Now  trim  off  the  sides  down  thin=like;  and, 
where  3"ou  thus  remove  the  compoimd,  trace= 
on  some  sticky=wax  to  stick  your  teeth  to. 
(Good  sticky = wax  is  made  of  three  parts  bee's= 
wax  and  one  part  rosin,  melted  together  and 
strained  into  a  porcelain  plate.) 


80  Greene  Brothers'  Ceinicae  Course 

Now  stick  your  teeth  onto  the  sticky=wax, 
.seeing  first  that  the  centrals  are  in  proper  po- 
sition. Then  put  it  all  into  the  mouth  and  ask 
patient  to  bite  down  lightly  and  slowly — "Slow- 
ly, Madam,  slowly!" 

When  the  teeth  show  the  desired  length, 
stop  her — "Stop,  stop.  Madam;  stop  there!" 

You  now  have  the  show 4ength  of  the  teeth. 

Now,  while  she  bites  down  steadily,  use 
your  fingers  to  adjust  the  teeth  down  onto  the 
occluding  lower  ones.  That  is,  adjust  them  to 
come  together,  just  as  you  want  them;  and 
also  to  fill  out  the  lip  as  you  want  it — well, 
just  as  you  always  do  in  fitting  an  articulated 
set  of  teeth  on  a  base=plate  in  the  mouth.  In 
fact,  you  are  simply  using  the  tested  impression 
as  a  base=plate. 

When  the  teeth  are  occluded  and  adjusted 
to  the  features,  take  the  case  out  of  the  mouth, 
cool  it  thoroughly,  and  "wax  up"  the  teeth  as 
usual.  While  the  waxing=up  is  being  done,  the 
impression  should  be  kept  cool  inside  by  cold 
wet  cotton  in  it. 

Now  place  it  back  into  the  mouth,  and,  if 
necessary,  re=conform  and  re=posUdam-  it. 

When  it  looks  and  fits  as  you  want  it  to, 
take  it  out  and  cool  it  well.  Then  pour  the 
model;  that  is,  fill  the  impression,  and  at  same 
time  half=flask  it,  in  the  usual  way,  teeth  up- 
ward. Your  case  is  now  in  first  half  of  the 
flask,  but  the  teeth  are  still  on  the  thick  im- 
pression instead  of  on  a  thin  wax  base=plate. 

Now,  as  soon  as  your  model  under,  or  in, 
impression  is  hard,  take  your  pocket=knife  and 
heat  the  point  of  it  and  cut  down  through  the 
compound  impression,  all  around  on  the  palatal 
side  of  the  teeth,  and  remove  the  com.pound. 

Then  slip  in  thin  base=plate  wax  where  the 
compound  came  from,  and  wax  up  all  around 


IN  Dental  Prosthesis.  81 

on  the  inner  side  of  the  teeth.  Sometimes  we 
place  a  strip  of  modehng  compound  on  the  OTit- 
er  side  of  the  teeth,  and  cool  it,  to  hold  them 
to  place  while  we  wax  =  up  on  their  aforesaid 
palatal  side. 

When  the  case  is  waxed,  you  are  ready  to 
double= flask  it.  See  that  the  metal  edges  of 
your  flask=rims  come  together  without  rocking. 
This  to  preserve  your  occlusion. 

Now,  in  filling  the  first  half  of  the  flask,  be 
sure  to  fill  the  impression  carefully  first,  without 
bubbles;   for  that  becomes  the  model. 

On  opening  flask,  merely  warm  it,  for  it 
won't  do  to  heat  modeling  compound;  and  there 
is  some  of  your  hnpression  in  there  yet. 

Finally  pack  and  vulcanize  and  finish  as 
usual.  As  your  impression  gave  you  the  length 
and  depth  of  your  plate,  and  the  thin  wax 
base=plate  gave  it  the  thickness,  there  will  be 
little  or  no  filing  or  scraping  to  do;  so  the 
finishing  will  be  btit  a  short  job. 

But  understand  me:  Quick  plates  are  justi- 
fiable only  in  cases  of  emergency  and  "push- 
ency."  They  shouldn't  be  made  from  a  com- 
mercial point  of  view. 

To  make  a  good  rubber  plate,  more  time 
should  be  used  by  the  case  in  the  flask  after 
the  flask  is  cold,  to  say  nothing  of  the  proper 
slowness  in  cooling.  Every  vulcanite  case  should 
be  left  in  the  flask  over  night  to  "season,"  if 
possible. 

There  are  other  ways  to  make  quick=step 
dentures.  But  this  is  preluding  and  forestalling 
our  third=lecture  lesson. 

Refitting  of  Plates. 

In  all  plate=work  practice  there  is  no  more 
common  need  than  refitting  of  plates.  And  yet 
in  my  travels  among  dentists,  ten  months  in 


82  Greene  Brothers'  Clinical  Course 

the  year  for  ten  years,  I  've  not  found  more 
than  one  in  ten  who  knows  even  the  old  meth- 
ods of  doing  this  simple  work;  the  exceptions 
being  largely  in  f aA'^or  of  the  old=timers  in  ' '  me- 
chanical dentistry." 

When  plates  don't  fit,  they  are  usually 
"made  over,"  at  much  loss  of  time  and  incon- 
venience and  with  the  tisual  uncertainty  almost 
inseparable  from  guess=work  methods. 

The  old  way  of  refitting  a  plate  is  simply  to 
line,  or  "half=sole,"  its  surface.  And  it  is  a 
partial  success,  as  far  as  it  goes.  But  it  doesn't 
contemplate  an}^  re=adjustment  of  the  teeth  in 
any  way,  nor  does  it  include  the  rim=and=heel= 
valve  fit  that  I  've  shown  you  on  full  plates. 
And  these  things  that  the  old  way  doesn't  in- 
clude are  among  the  most  necessary  of  all.  For 
the  refitting  of  merely  the  main  surface  of  a 
plate  is  often  curing  but  a  small  part  of  the 
whole  trotible. 

Now  I  will  show  you  how  to  refit  the  whole 
thing,  including  occlusion  and  position  of  teeth 
if  needed: 

Temporary  Refit  with  Modeling 
Compound. 

I  '11  assume  you  want  to  make  only  a  partial 
refit,  and  that  only  temporary,  till  you  get  time 
to  re= adjust  and  refit  it  fully  and  permanently. 

This  is  done  with  "Perfection"  modeling 
composition.  You  '11  keep  on  hand  a  supply 
of  thin  sheets  of  it,  say  one=sixteenth  of  an  inch 
thick.  You  can  make  them  by  simply  press- 
ing soft  compound  out  on  a  slab  of  glass  or 
marble  with  a  bottle  or  common  tumbler.  But 
the  Detroit  Dental  Manufacturing  Company  are 
putting  this  on  the  market.  You  '11  keep  dif- 
ferent thicknesses  of  these  ready=made  "wafer" 
sheets  on  hand. 


IN  Dental  Prosthe;sis.  83 

To  refit,  you  first  scrub  the  plate  clean  and 
sand=paper,  or  scrape,  its  palatal  surface  a  lit- 
tle; then  dr}^  it  well.  Then  heat  your  wafer 
sheet  of  compound  and  lay,  it  onto  the  plate 
and  rub  hard  till  it  attaches  perfectly  thereto — 
not  merely  till  it  presses  closely,  but  till  it  actu- 
ally adheres.  This  must  cover  the  whole  surface, 
of  course. 

Next  press  another  thin  wafer  onto  this  first 
one,  still  dry  heat.  Then  dip  the  plate  into  hot 
water  to  soften  the  comipotmd,  and  quickly  put 
it  into  patient's  mouth  and  have  her  bite  down 
lightly  on  the  teeth. 

Do  this  two  or  three  times,  when  3^ou  '11 
have  a  good  (old=fashioned)  refit  in  "Perfec- 
tion" compound  that  will  remain  for  days  or 
weeks,  owing  to  the  thoroughness  of  the  work. 
And  you  have  done  it  in  a  very  few  minutes. 
But  don't  forget  to  tell  patient  not  to  heat  her 
plate  in  hot  water  nor  otherwise. 

Should  the  mouth  change  again,  or  the  com- 
pound get  displaced,  simply  re=heating  in  hot 
water  and  re=adjustment  may  be  sufficient  for 
another  correction. 

This  temporary  refitting  with  modeling  com- 
pound applies  to  metal  plates  as  well  as  to  vul- 
canite and  celluloid;  when  done  with  proper 
thoroughness,  of  course. 

But  compound  won't  stick  to  the  edges  of 
plates;  so  this  couldn't  be  even  a  complete 
temporary  refit,  though  good  as  far  as  it  goes. 
Complete  refits  must  include  the  edges  of  plates 
as  well  as  the  palate  and  ridges. 

Permanent  Refits  with  Vulcanite. 

To  refit  a  vulcanite  plate  completeh^  and 
permanently  —  rim,  heels,  and  tuberosity,  in- 
cluding position  of  teeth  and  occlusion, — you 
first  see  that  the  teeth  stand  as   desired.     If 


84  Greene  Brothers'  Clinical  Course 

not,  oil  them  and  heat  them  with  a  mouth 
blow=pipe,  and  push  and  pull  them  to  the  po- 
sitions desired,  and  hold  them  in  place  till  cool. 
This  relates  mostly  to  the  front  six,  but  may 
include  any  others. 

If  there  are  any  cracks  in  the  plate  from 
changing  position  of  the  teeth,  pack  softened 
vulcanite  into  them,  as  you  'd  pack  soft  foil 
into  a  carious  cavity. 

Next  see  that  the  teeth  occlude  with  their 
opponents  as  you  want  them  to,  whether  the 
latter  be  natural  or  artificial. 

Not  necessary  that  the  plate  itself  should 
even  touch  the  mouth  in  this  re=occlusion;  just 
so  that  the  teeth  come  together  properly. 

If  any  tooth  is  too  long,  either  grind  it  off 
or  take  it  out,  make  more  room  above  it  and 
then  set  it  back  up  deeper  into  the  plate.  If 
one  is  too  short,  loosen  it  and  pull  it  down  to 
proper  touch  against  its  opponent. 

Your  teeth  now  both  set  and  occlude  as 
you  wish  them  to. 

Next  file  the  rim  of  the  old  plate  down  be- 
low where  there  is  any  under  =  cut,  including 
around  the  tuberosities,  and  trace=on  enough 
modeling  compound  for  a  new  rim;  and  cover 
the  whole  palate  and  ridge  surfaces  with  a  fac- 
ing of  thin  compound,  as  in  a  temporary  fit  with 
compound. 

With  your  material  thus  in  place,  dip  the 
plate  into  hot  water  and  have  patient  take  her 
own  impression  (in  the  old  denture)  by  biting 
down  lightly.  Do  this  twice  or  three  times  if 
necessary.  When  it  will  stick  up  in  the  mouth, 
that  's  proof  that  it  fits. 

When  the  roof  and  ridge  stand  the  test, 
then  go  on  and  very=edge  the  rim  all  around. 
Be  sure  each  muscle  has  valve=tight  room  to 
move  in;    that  is,  relief  without  leak. 


IN  Dental  Prosthesis.  85 

Then,  next,  you  '11  conform  all  around,  in- 
cluding behind  tuberosities,  as  in  an  original 
impression. 

Till  now  we  've  left  the  most  important  step 
yet  to  be  done:  the  valve=fitting  of  the  pos- 
terior edge  of  our  plate's  palate. 

If  the  old  plate  reaches  back  to  where  it 
should — that  is,  onto  the  yielding  soft,  and  not 
onto  the  moving,  straining  soft, — it  has  been 
already  post=dammed,  in  the  taking  of  the  im- 
pression, by  biting.  That  is,  the  hard  plate 
has  forced  the  compound  up  against  the  soft 
tissues  and  made  the  needed  valve  =  pressure 
strain  there. 

If  it  doesn't  go  back  far  enough,  you  '11  file 
it  off  square  and  trace  =  on  enough  modeling 
compound  to  make  it  reach  into  the  stationary 
soft  tissues.  File  it  square  to  vulcanize  more 
length  onto  it. 

When  you  get  it  long  enough,  with  a  little 
to  spare,  you  then  apply  the  rules  for  getting 
■  exact  length,  and  post=dam  properly,  preferably 
by  Method  A — tongue  pressure. 

You  now  have  the  set  of  teeth  as  you  want 
it.  It  stands  the  test  of  mouth  movements. 
Get  your  flask  ready.  See  that  its  edges  fit 
together  in  a  way  not  to  allow  any  tilting,  for 
that  might  harm  the  occlusion. 

Fill  the  lingual  side  of  plate  carefully  with 
plaster,  avoiding  all  air= bubbles,  and  at  same 
time  fill  the  first  half  of  the  flask  with  plaster, 
and  push  plate  into  it  with  teeth  pointing 
downward.  Then  scrape  off  excess  plaster  and 
varnish  as  usual  in  flasking. 

Now  fit  on  the  ring  of  your  flask  and 
"double=flask."  First  carefully  fill  your  im- 
pression, same  as  if  you  were  making  a  model; 
for,  indeed,  that  's  what  you  are  doing — the 
very  one  you  are  going  to  vulcanize  onto. 


86  Greene  Brothers'  Clinical  Course 

Let  your  plaster  harden  well,  the  remainder 
in  your  bowl  being  your  guide.  When  hard, 
place  the  flask  over  a  spirit  flame  or  on  a  warm 
stove  and,  when  you  can  feel  it  is  slightly  warm 
through,  open  from  the  heel  first. 

Your  flask  is  opened,  and  your  model  is  in 
the  last  half  of  it.  Cover  it  with  thin  tin= 
foil  and  cut  some  small  vents,  and  it  's  ready 
for  use. 

Now  turn  to  the  set  of  teeth  in  the  first 
half  of  the  flask,  remove  the  compound  and 
scrape  the  old  plate  to  get  a  new  surface;  then 
pack  and  vulcanize  as  usual.  But  leave  all 
vulcanized  cases  in  flask  for  several  hours  be- 
fore opening,  if  possible. 

.  It  takes  time  as  well  as  cool  temperature 
for  vulcanized  rubber  to  crystallize  to  its  best — 
to  "season."  Leave  case  in  flask  over  night 
when  you  can.  Quick  vulcanizing,  quick  cool- 
ing and  quick  removal  all  help  to  make  brittle 
and  warping  plates;   don't  doubt  that. 

If  3^ou  've  followed  instructions,  your  plate 
will  come  out  clean  and  nearly  finished — ^no 
filing,  no  scraping,  and  little  polishing.  Re- 
move the  tin=foil  with  a  thin  amalgam  of  mer- 
cury and  tin=foil,  or  tea=lead,  made  in  your 
hand  and  rubbed  on  with  your  finger  or  a  wad 
of  cotton. 

To  Refit  with  Plaster  Impression — 
' '  Pass=Word  Method.  ' ' 

•  If  you  wish  to  take  the  impression  in  plas- 
ter, you  simply  first  file  off  the  old  rim  and 
heels  and  add  compound,  and  very=edge  and 
conform  and  post  =  dam,  so  as  to  confine  the 
plaster;  and  then  take  it  according  to  the  ' '  pass- 
word. "  (Index  P.)  Of  course  the  patient  will 
bite  down  to  get  the  impression,  instead  of  you 
pushing  it  up  in  her  mouth.      (Index  P.) 


^'  IN  Dental  Prosthesis.  87 

Common,  Old=Fashioned  Refit  of 
Rubber  Plates. 

But  if  you  want  to  make  merely  a  common, 
old = way  refit,  you  can  do  so  by  merely  taking 
the  impression  in  plaster  or  compotmd  alone, 
without  our  improvement  in  muscle  relief=with- 
out=leak  and  our  rim  and  heel  valve =pressure 
fitting. 

And  you  can  do  it  in  a  sort  of  approximate, 
half=shod  way  by  using  semi=liquid  vulcanite 
paste  for  taking  the  impression.  But  these 
preparations  will  not  properly  equalize  press- 
ure even  on  difficult  plain  surfaces,  to  say  noth- 
ing of  their  utter  lack  in  muscle=trimming  and 
valve  =  edge  =  pressure  qualities,  so  essential  in 
good  plate  =  work.  They  are  poor  substitutes 
for  good  compound  or  fine  plaster.  (Coarse  com- 
potmd and  coarse,  stiff  plaster  won't  do  at  all.) 

Until  you  "get  your  hands  in"  by  a  little 
experience,  you  may  get  the  best  results  in  re- 
fitting by  using  impression  plaster  according  to 
the  five  points  of  the  ''pass=word."  (Index  P.) 

To  Reproduce  Plates  froai  Old  Ones.     , 

You  can  generally  get  a  few  more  dollars, 
and  do  your  patient  more  justice,  by  substi- 
tuting a  new  plate  in  place  of  the  old  one,  in- 
stead of  refitting  the  latter.  And  it  '11  take 
3^ou  but  a  few  minutes  longer  and  cost  3'ou  but 
a  few  cents  more. 

First  get  your  contract  to  refit,  and  go  on 
and  take  your  impression  for  that  purpose. 
Then  inform  patient  that  while  3^ou  can  and 
will  be  responsible  for  the  fit,  you  can't  be  for 
the  breaking  of  the  plate;  since  every  time  an 
old  plate  is  vulcanized  it  becomes  more  brittle 
and  more  liable  to  break  again.  But  you  '11 
put  in  all  new  material  and  then  warrant  the 
new  plate   not  to   break.     (First=class   rubber, 


88  Greene  Brothers'  Clinical  Course 

properly  vulcanized  at  lowest  temperature,  long 
time,  against  tin=foil  or  gold=foil,  will  not  break.) 

A  patient,  after  you  have  begun  her  work, 
will  very  seldom  refuse  to  give  you  big  pay  for 
your  extra  few  minutes  in  making  her  a  new 
plate  instead  of  refitting  her  old  one. 

To  do  this,  3^ou  do  just  what  I  have  de- 
scribed and  shown  you  in  refitting,  from  the 
first  to  last,  up  to  the  time  you  are  to  remove 
the  material  that  constituted  the  impression, 
ready  for  packing.  But,  instead  of  removing 
the  impression  material  and  scraping  a  new 
surface  on  the  old  plate,  3^ou  just  remove  the 
whole  thing,  plate,  material  and  all,  and  pack 
for  an  entire  new  plate,  instead  of  for  a  lining. 

This  is  done  by  placing  the  half = flask,  con- 
taining the  set  of  teeth,  over  a  hot  flame  and 
heating  it  hot,  and  lifting  out  the  plate  from 
its  imbedment;  usually  teeth  and  all. 

As  you  lift  it  out,  some  of  the  plaster  around 
the  teeth  may  break  loose ;  but  just  cement  the 
pieces  back  to  their  places  and  go  on. 

Heat  your  teeth  on  the  plate  (after  oiling 
them  to  prevent  cracking)  by  pressing  them 
back  and  forth  over  a  small  spirit  flame,  and 
pull  'em  off  in  the  usual  way.  Then  stick  each 
one  back  into  its  place  in  the  investment,  pa}^- 
ing  no  attention  to  the  little  rubber  that  may 
remain  fast  to  the  pins — it  '11  .do  no  harm. 

Pack  and  vulcanize  just  as  for  a  new  set  of 
teeth.  Then  you  have  made  a  new  plate,  out= 
and=out,  with  no  more  work  and  but  a  few- 
cents  more  cost  to  you  than  to  have  refitted 
the  old  rotten  one. 

But,  now,  bear  in  mind,  if  you  know  in  ad- 
vance that  you  're  going  to  renew  instead  of 
refit  the  case,  you  can  and  should  use  wax  in 
changing  the  position  of  the  teeth  of  the  old 
plate  (before  taking  the  impression  therein),  in- 


IN  Dental  Prosthesis.  89 

stead  of  packing  the  cracks  with  vulcanite,  as 
in  refitting. 

In  this  renewal,  if  the  old  plate  didn't  fit 
nor  the  teeth  set  right,  all  will  be  corrected 
together  in  the  new  plate. 

You  can  refit  or  renew  broken  plates  in  this 
way:  Fasten  the  two  or  more  pieces  together 
with  common  filling  cement  or  else  wise,  trim 
down  the  old  rim  and  take  the  impression  as 
I  have  shown  you,  either  in  "Perfection"  ma- 
terial, or  in  plaster  by  the  "pass=word"  way. 
Then  go  on  as  you  have  been  show^n.  If  you 
use  cement  to  fasten  the  pieces  together,  better 
strengthen  with  piano  wire  additionally. 

And  bear  in  mind,  in  all  these  repairs,  re- 
fittings  and  renewals  you  can  test  in  advance 
for  final  results,  the  same  as  in  testing  full 
impressions. 

The  Greene  Ready=Made,  Non= 

Changeable  Models. 

To  make  sure  of  no  change  from  your  test 
impression  by  faulty  plaster  models,  or  mal= 
use  of  even  good  ones,  you  can  use  the  Greene 
ready =made  non=changeables  in  refi.tting  and  re- 
newing plates,  the  same  as  in  original  work. 
And  you  should  especially  use  them  if  you  turn 
yotir  work  over  to  ignorant  or  careless  assist- 
ants or  other  irresponsible  helpers. 

Precaution  in  Refitting  and 
Renewing  Plates. 

If  your  plate  is  thick,  scrape  it  down  on  the 
lingual  side  and  polish  it  before  having  patient 
take  her  impression;  else  you  may  get  your 
new  plate  too  thick.  Also  have  your  impres- 
sion material  soft  enough  that  the  old  plate 
ma}^  show  through  it  at  places  for  the  same 
reason  just  given. 


90  Greene  Brothers'  Clinical  Course 

Also  see  that  you  don't  get  too  much  rubber 
in  your  packing  and  that  you  have  ample  vents 
for  surplus,  to  prevent  over=  strain  in  squeezing. 
Better  always  use  the  cloth  plan  in  packing. 

Also  think;  if  you  fail  to  get  the  metal  edges 
of  flasks  together,  your  plate  will  be  correspond- 
ingly too  thick  and  the  teeth  that  much  too 
long  somewhere.  Most  of  the  points  of  this 
lecture,  now  closed,  will  be  further  illustrated, 
in  our  next  two  lectures,  in  their  application 
to  other  work. 


IN  Dental  Prosthesis.  91 


LECTURE  NUMBER  TWO. 


LOWER  DENTURES. 


First:     A  Modeling-Compound  Impres- 
sion IN  Detail. 

Well,  doctors,  we  now  come  to  what  gives 
more  trouble  to  dentists  generally  than  any 
other  part  of  plate=work.  In  fact,  to  most  of 
them  it  's  the  most  difficult  of  all  dental  work. 
That  is  the  making  of  lower  full,  or  partial,  sets 
of  teeth  satisfactorily. 

In  this  clinic4ecture  we  '11  simply  apply  the 
principles  laid  down  and  explained  in  vSection 
No.  I,  so  far  as  they  are  applicable.  With  these 
principles,  in  connection  with  others  especial  to 
lower  cases,  I  hope  to  show  you  that  it  is  as 
simjjle  and  easy  to  reach  satisfaction  in  diffi- 
cult lower  cases  as  in  difficult  upper  ones. 

As  we  did  in  the  upper,  so  we  '11  commence 
with  a  modeling= compound  impression  and  a 
full  ("double")  case. 

In  lower  cases  the  common  deep  and  long 
old  trays,  used  in  the  usual  old  ways,  are  even, 
if  possible,  more  absurd  than  in  upper  ones. 

Such  trays  being  longer  and  broader  and 
deeper  than  your  expectant  denture  is  to  be, 
you  not  only  take  in  more  area  of  the  mouth 
than  is  needed,  but  generall}?-  distort  the  parts 
the  plate  is  to  cover. 

Take  an  impression  of  a  distorted  mouth 
and,  of  course,  the  plate  won't  fit  it  when  it 
resumes  its  normal  shape. 

^,With  a  too  extensive  tra}^  you  not  only 
press  the  soft  and  loose  tissues  out  of  place, 
but  you  strain  the  moving  muscles.     You  take 


92  Greene  Brothers'  Clinical  Course 

the  impression  of  the  moving  muscles  when 
strained  down.  Then,  when  you  insert  the  re- 
sultant plate  on  them  without  strain,  of  course 
they  rebound  and  lift  it  up.  Then  you  diag- 
nose the  case  as  maybe  one  of  the  "Johnny= 
jump=ups." 

Then  3^ou  file  the  plate  off  by  guess  to  re- 
lieve the  muscular  strain,  when  it  turns  out, 
in  most  cases,  that  you  've  cut  off  too  much 
and  have  a  leak,  as  well  as  a  relief.  What  is 
needed  is,  again,  relief  without  leak. 

The  old  college  professor's  rule,  "Trim  your 
lower  plate  till  you  think  you  have  spoiled  it, 
and  then  trim  it  more  till  you  are  sure  you 
have  spoiled  it,"  is  a  grave  error,  to  put  it 
mildly.  Scores  of  them  seem  to  think  they  in- 
dividually originated  the  "gag." 

Lower  plates  should  cover  all  the  territory 
compatibly  possible,  to  have  corresponding  areal 
contact  and  consequential  atmospheric  pressure, 
or  "suction."  The  less  areal  contact,  of  course, 
the  less  chance  for  atmospheric  push=down. 

The  fact  is,  the  very  contrary  of  the  ' '  keep= 
on=trimming"  advice  is  true.  The  more  of  the 
ever=present  saliva  bed  that  is  covered  by  a 
lower  denture,  the  better  suction  it  will  have; 
provided  the  tissues  are  not  strained,  of  course. 
This  is  simply  self=evident  to  an 3^  one  who  can 
reason  at  all. 

But  this  matter  of  extension  and  limit  is 
one  to  be  dealt  with  an  hour  later  on.  For 
the  present,  we  want  to  take  a  lower  impres- 
sion of  the  parts  in  their  normal  position,  and 
without  undue  strain  on  the  moving  muscles. 

In  some — in  fact,  many — cases,  we  must  im- 
avoidabh^  cover  these  straining  tissues;  other- 
wise our  plate  would  be  so  "trimmed"  as  to 
have  little  or  nothing  left.  I  find  many  such 
ones. 


IN  Dental  Prosthesis.  93 

Now,  to  take  an  impression  of  a  flexible  tis- 
sue with  room  for  reflex  action  is  the  problem. 

We  '11  illustrate  by  taking  it  first  in  a  way 
almost  sure  to  fail;  which  means  the  old  wa}^ 
in  common  use.  But,  first  of  all,  we  11  find 
and  inspect  the  muscles  most  concerned. 

Now,  each  one  of  you  place  your  right  in- 
dex finger  in  your  mouth,  left  side,  for  instance, 
as  far  back  as  you  can  get  it,  on  the  outside 
of  your  lower  teeth.  And,  as  you  press  down, 
open  and  close  your  mouth,  and  especially  bite 
down  on  your  finger — several  times,  please. 

I  see  you  look  surprised,  for  you  know  what 
it  means.  You  quickly  anticipate  my  talk.  You 
have  learned,  before  I  tell  you,  just  what  hap- 
pens when  you  use  a  long,  broad=ended  metal 
tray  in  taking  an  impression  of  a  masseter  mus- 
cle and  its  coverings. 

You  take  it  in  a  relaxed,  at=rest,  or  even  a 
strained=down  condition.  When  you  open  and 
close  your  mouth,  and  especially  when  you  bite 
doivn  on  your  finger,  you  feel  what  irresistibly 
lifts  it.  It  lifts  up  even  though  }'ou  bear  down 
with  several  pounds'  pressure. 

Speaking  practically  from  a  resistance  stand- 
point, you  can  and  do  take  a  lower  impression 
in  this  wa}^  (with  your  thumbs)  at  many  pounds' 
strain  pressure. 

While  you  don't  exactly  push  down  on  your 
extended  metal  tray  at  a  twenty  or  forty  pounds' 
strain,  you  do  take  that  part  of  the  impression 
in  a  way  to  give  the  masseter  muscle  and  its 
surroundings  so  much  capacity  to  lift  the  plate ; 
and  they  use  as  much  of  the  capacit}'  as  is 
necessary  to  lift  it. 

These  figures  are  correctly  illustrative,  if 
not  exact. 

Why,  doctors,  I  see  some  of  you  are  so  h\-p- 
notized  with  concentrated  surprise  that  you  are 


94  GrE£;ne;  Brothers'  Cunical  Course; 

still  holding  down;  down  on  the  main  muscle 
that  causes  so  many  of  your  lower  plates  to 
have  the  "  Johnny =jump=ups." 

Now,  how  are  you  going  to  take  an  impres- 
sion over  and  of  these  muscles  and  avoid  the 
jump=ups  in  your  plate  ? 

Some  one  suggests  the  common  old  method 
of  "relief"  by  cutting  away  the  denture  plate 
to  give  the  straining  tissues  room  to  move  in 
with  freedom. 

Yes,  if  you  file  it  away  enough,  that  will 
relieve  it.  But  in  cutting  off  your  plate  short 
at  rear  (or  even  at  side=rear),  you  lose  the  most 
useful  and  most  effective  part  that  operates  to 
hold  it  down;  that  is,  the  most  effective  part 
when  it  is  properly  fitted  and  left  there. 

By  filing  it  off,  you  lose  not  only  just  so 
much  area  of  contact  for  atmospheric  pressure, 
but  lose  it  at  the  longest  and  most  powerful 
end  of  the  lever. 

The  farther  back  a  plate  reaches,  the  longer 
your  lever  is;  arid  the  more  surface  it  covers, 
the  greater  the  power  at  the  long  end  of  the 
lever.  This  is  simply  mechanical  philosophy 
that  no  one  will  gainsay;  assuming  the  fact 
that  the  front  teeth  constitute  the  fulcrum  in 
the  calculation. 

Assuming  there  is  no  under=push  upward, 
like  a  straining  tissue,  it  would  be  a  matter  of 
only  a  little  atmospheric,  or  other  weight,  to 
prevent  rear  tipping. 

If  the  plate  is  left  long,  or  broad,  saliva  gets 
under  it  and  operates  like  water  between  two 
pieces  of  glass,  when  they  "stick"  together — 
according  to  area  of  contact. 

Hence  the  mechanical  value  in  the  length 
of  a  lower  plate.  But  the  condition  is,  there 
must  be  no  uplifting  understrain  to  offset  the 
atmospheric  down=push,  of  course. 


IN  Dental  Prosthesis.  95 

To  Avoid  Straining  the  Muscles. 

Then  let  's  take  the  impression  in  the  first 
place,  so  as  not  to  strain  the  masse ters,  or  other 
mtiscles. 

The  first  requisite  in  this  is  to  fit  tJie  tray 
to  the  mouth. 

We  '11  take,  if  need  be,  an  old,  soft=metal 
tray  and  with  curved  plate = shears  cut  it  of[  be- 
hind; and  trim  it  down  in  front;  and  narrow 
the  sides;  until  it  is  even  shorter  at  rear,  and 
shallower  everywhere,  than  our  coming  finished 
plate  is  to  be;  especially  shorter  at  rear.  For 
we  don't  want  it  to  run  back  onto  the  condyles, 
nor  onto  the  troublesome  masseters  at  their 
outer  sides.  If  we  strain  things  about  the  con- 
dyle vicinity  with  only  our  material,  we  can  cor- 
rect that.  And  it  is  only  a  correctable  impres- 
sion that  we  are  preparing  to  take,  at  first. 

Besides  reducing  the  old  tra}^  in  length  and 
depth,  we  '11  also  cut  its  handle  off  to  about 
three = quarters  of  an  inch;  then  thin  tJiat  down, 
so  as  to  reduce  over=lapping  w^eight  and  avoid 
tipping. 

A  long,  heavy  handle  to  a  lower  impression 
tray  is  about  as  useful  (and  about  as  much  in 
the  way)  as  a  rhinoceros's  hom=snout  would 
be  on  a  pet  pug's  face.  How  nicely  the  com- 
parative rhinoceros=hom  would  teeter  the  pup- 
py! And  how  vigorously  a  long,  heav}^  handle 
would  teeter  a  lower  impression  when  you  let 
go  for  a  stay=down  test! 

And  3^et  our  "best  men"  never  kick  to  go 
into  a  supply  house  and  find  none  but  honi= 
snout=laden  lower  impression  tra3^s  in  the  well= 
filled  show=  cases. 

The  metal  tray  should  fit  the  alveolar  ridge 
(or  over  where  it  used  to  be)  approximately 
well,  so  we  can  use  a  small  amount  of  impres- 
sion material. 


96  Grekne  Brothers'  Clinical  Course 

Such  a  tray,  with  minimum  contents,  is  a 
great  convenience  to  the  dentist  and  satisfac- 
tion to  the  patient.  All  told,  our  bulk  shouldn't 
be  twenty  per  cent  of  the  average  in  common 
practice,  by  old  methods.  As  in  the  upper  case, 
there  are  two  ways  of  fitting  a  tray  to  a  lower 
mouth. 

The  -first  is  the  student's  way — a  good  way, 
too,  for  anybody. 

In  this  way,  with  a  medium  tray  ("de- 
homed"  over  masseter  region),  we  first  take 
a  hurried,  approximate  impression  in  mxodeling 
compound,  and  cool  it  somewhat  in  the  mouth 
with  cold  water,  thrown  in  with  a  piston  syringe. 
Then,  with  quickening  salt  or,  better,  sulphate 
of  potash,  make  a  hurried,  approximate  plaster 
model.  Then  with  the  thumb  and  fingers,  or 
pliers,  bend  the  tray  to  fit  it  approximately, 
turning  the  heels  of  the  tray  up  a  very  little, 
to  prevent  metallic  rear=gouging. 

The  second  is  the  practitioner' s  way — which 
is  quicker,  but  less  accurate;  but  usually  good 
enough.  This  is  to  get  right  in  front  of  the 
patient's  face,  and  with  the  right  hand  enter 
the  right  wing  of  the  tray  into  the  mouth,  as 
a  farmer  does  the  rails  of  his  "bars"  (gate). 
Then  let  go  of  the  handle,  and  with  both  in- 
dex fingers  spread  the  lips  a  little  and  look  in. 

If  we  let  go,  the  tra}^  will  drop  down  and 
center  itself  over  the  ridge,  or  place  of  the 
ridge,  by  cheek  and  tongue  guidance  and  its 
own  weight. 

We  '11  examine  its  needs  and  take  it  out 
and  expand  or  contract  its  wings,  and  turn 
its  heels  up  or  down  till  it  approximately  fits 
the  jaw. 

Never  attempt  to  hold  the  tray  down  in 
place  to  inspect  it,  but  let  it  seek  its  own  po- 
sition, freed  from  cheek=and=lip  hindrance. 


IN  Dental  Prosthesis. 
LOWER  TRAYS. 


97 


Fig.  9  —  Monstrosity.     "Begat"  Absurdity 


Fig.  II. — Compromise. 
For  large  ridge. 


Fig.  lo. — Absurdity. 
Too  large  for  any  nioulh. 


Fig.    12. RE.VSON.A.BLE. 

For  medium  size. 
[These  cuts  represent  three-fourths  of  full  size  of  lower  trays.] 


98  Greene  Brothers'  Clinical  Course 

The  next  step,  after  fitting  the  tray  by 
either  method,  is  to 

Take  a  Correctable  Impression. 

By  "correctable"  I  mean  one  where  no  part 
of  the  metal  comes  in  contact  with  the  tissues 
of  the  mouth.  We  are  going  to  correct  up  this 
impression  by  mouth  and  tongue  movements 
on  sensitized  surfaces;  but  we  couldn't  thus 
correct  a  metal  tray. 

Students  and  novice  practitioners  are  ad- 
vised to  take  this  correctable  impression  from 
the  approximate  model  that  they  first  fitted  the 
tray  to;  then  afterwards  fit  it  to  the  mouth, 
as  now  soon  to  be  described. 

To  take  the  correctable  impression  from 
the  approximate  model  is  very  simple.  First 
rub  the  model  well  with  pulverized  soapstone. 
Then  make  a  little  roll  of  warm  modeling  com- 
pound in  your  hands  and  press  it  carefully  down 
onto  the  prepared  model.  Then  press  the  fitted 
tray  dow^n  onto  the  compound. 

While  we  finger=press  the  compound  around 
the  edges  of  the  tray  to  the  model,  we  '11  not 
forget  to  turn  a  little  of  it  over  onto  the  back, 
or  reverse  side,  of  the  tray,  and  touch  it  with 
our  finger,  dipped  in  cold  water,  to  clinch  the 
tray  and  compound  together. 

We  have  here  now  taken  a  correctable  im- 
pression of  the  approximate  model;  the  next 
thing  is  to  separate  them.  We  must  begin  the 
separation  before  the  impression  material  gets 
anything  like  hard.  And  right  here  is  where 
some  of  the  class  may  get  things  mixed  up  a 
little.     Watch  close  and  listen  carefully! 

While  yet  warm,  we  '11  dip  the  whole  thing 
into  cool  water  for  a  very  few  seconds,  to  chill 
the  impression  a  little.  Now  we  '11  take  it  out 
and  Cjuickly  pull  it  partly  loose  from  the  model 


.  IN  Dental  Prosthesis.  99 

at  the  heel;  hurriedly  re=dip  it  back  to  let  the 
cool  water  under  it;  jerk  it  out  and  instantly 
re=press  it  back  tightly  to  the  model;  and  stick 
it  back  to  fully  cool.  After  cooling,  we  '11  sep- 
arate carefulh'. 

If  we  at  first  let  the  compound  cool  fully 
without  this  precaution,  we  might  find  the  sep- 
aration difficult  in  some  cases. 

And  there  are  a  few  instances  where  we  have 
to  "core  out  "  under = cuts  before  taking  an  im- 
pression of  a  model.  In  this,  we  simply  jirst 
fill  up  the  under=cut  with  compound,  and  cover 
it  with  tin=foil,  and  soapstone  the  foil;  then 
go  on  and  take  the  impression  as  I  've  just 
described. 

Doctors,  be  sure  you  understand  me  in  sep- 
arating an  impression  from  a  model,  when  we 
wish  to  preserve  the  impression,  as  we  do  in 
this  instance. 

Don't  attempt  to  take  an  impression  of  a 
model  without  first  soapstoning,  or  otherwise 
treating  it,  to  prevent  adhesion;  and  then  don't 
get  your  compound  too  warm — never  hot. 

We  now  have  a  correctable  impression  from 
the  approximate  model  (student's  way);  and 
are  ready  to  adjust  it  to  the  mouth,  in  all  its 
parts  and  points  and  details — soon  to  be  shown. 

But,  before  we  show  you  how  to  correct  and 
adjust  a  student's  correctable  impression  to  the 
mouth,  we  must  return  to  the  practitioner's 
method  and  show  you  how  we  get  said  impres- 
sion directly  from  the  mouth.  The  corrections, 
after  taken,  are  similar  in  both  methods. 

I  he  practitioner's  way  is  the  shorter  one, 
but  r  ot  as  simple  r  or  as  easy  as  to  take  it  from 
the  ajjproximate  model,  outside  of  the  mouth. 
And,  only  for  the  inconsiderable  extra  ten  min- 
utes for  taking  the  student's  approximate  im- 
pression  and   making   the   approximate   model 


100  Greenk  Brothers'  Clinical  Course 

from  it,  I  'd  always  prefer  the  round=about  way 
of  getting  the  correctable  impression. 

I  have  learned,  mostly,  to  disregard  a  few 
extra  minutes  of  work,  for  convenience,  com- 
fort, better  results,  and  avoidance  of  future  an- 
noyance; especially  in  difficult  cases. 

Practitioner's  Correctable  Lower 
Impression. 

Our  metal  tray  has  been  fitted  to  the  mouth. 
(Index  F.)  Now  we  '11  take  a  small  hand=made 
roll  of  warm  compound — for  a  medium  case, 
about  one=fourth  inch  in  diameter — and  place 
it  onto,  or  into,  the  face  of  the  prepared  tray. 
(Tray  should  have  some  small  holes  through 
it,  to  help  fasten  the  impression  to  it.) 

The  roll  is  purposely  an  inch  or  more  too 
long;  so  we  '11  double  the  length= surplus  over 
onto  the  back,  or  reverse  side,  of  the  tray, 
press  closely,  and  finger= touch  it  with  cool  wa- 
ter, to  prevent  its  dropping  loose  when  we  turn 
it  over  to  take  the  impression  in  the  mouth. 

The  impression  m.aterial  being  fastened  to 
the  tray  and  finger=fashioned  ready  for  appli- 
cation, we  now  further  warm  it  till  quite  soft, 
by  passing  it  back  and  forth  over  our  handdamp 
flame. 

Before  entering  it  into  the  mouth,  we  '11 
look  the  patient  straight  in  the  face  and  say: 
"Madam,  this  is  warm,  but  don't  fear;  it  will 
not  burn  you.  "  This  forewarning  is  often  nec- 
essary to  forestall  a  false  suggestion  of  pain. 
Form  you  a  habit  of  forestalling  suggestion,  and 
save  both  yourself  and  patient  anno3^ance  and 
trouble. 

And  let  this  suggestion  include  the  gratify- 
ing fact  that  you  '11  not  choke  her — a  popular 
fear  of  impression=takings. 

We  are  standing,  or  sitting,  right  in  front 


IN  Dental  Prosthesis.  101 

of  our  patient,  who  is  seated,  preferably,  in  a 
common  chair  and  in  our  impression=room,  or 
clean  laboratory.  Our  small  alcohol=gas  water= 
heater  and  all  the  rest  of  our  needed  conveni- 
ences are  on  our  little  table  with  cleats  around 
its  edge  to  prevent  things  from  slipping  off. 

This  little  impression=table,  with  its  contents, 
is  at  our  right  hand  and  within  easy  reach. 

With  our  patient  sitting  up  straight  and 
head  in  natural  position,  we  hold  our  loaded 
tra}^  by  its  short  handle  between  our  thumb 
and  finger  (right  hand)  and  enter  first  the  right= 
hard  wing  into  the  mouth;  then  push  it  to  the 
right  and  enter  the  left  wing. 

As  soon  as  both  wings  are  well  in,  we  '11 
let  go  and  instantly  spread  the  cheek=lips  a  lit- 
tle with  our  index  fingers,  both  hands;  that  is, 
w^e  '11  pull  forward  a  little  and  spread  lightly. 

Now,  right  here,  doctors,  let  me,  even  in  ad- 
vance, caution  ^^^ou  not  to  make  this  lip= spread- 
ing "stunt"  too  roughly — as  you  '11  be  apt  to 
do.  Practice  it  first  on  each  other's  mouths, 
take  vour  scolding  kindly,  and  profit  thereby. 

This  light  spread=shaking  of  the  lip=cheeks 
gives  room,  and  our  tray  centers  and  settles 
down  instantly,  of  its  own  weight,  guided  by 
the  tongue  and  cheeks,  to  its  proper  place. 

It  is  in  position.  Standing,  or  sitting  (I  re- 
peat), right  in  front  of  my  patient,  I  quickly 
place  my  two  index  fingers  on  the  wings  of  ni}' 
tray  and  wave=press  down  gently  and  lightly; 
always  lightly. 

(I  expect  to  repeat  several  times  in  this 
Course  that  an  impression  should  be  taken  at 
about  the  strain  the  plate  is  to  be  worn.  x\ 
little  reflection  will  tell  you  why.) 

When  it  's  dow^n  to  place,  I  hold  it  there  a 
few  seconds  to  chill  a  very  little.  Now  watch 
close  w^hile  I  press  the  sides  of  my  impression 


102  GREE^^K  Brothers'  Clinical  Course 

to  place.  I  la}^  my  left  index  finger  on  top  of 
the  left  wing  of  my  tray  longitudinally — not 
cross=wise.  At  the  same  moment  I  put  my  left 
thumb  under  the  handle — or,  rather,  lip — of  the 
tray,  to  steady  it,  if  needs  be. 

While  I  thus  hold  the  impression  down  with 
m}^  left  index  finger,  I  run  my  right  index  fin- 
ger around  on  the  lingual  side  (under  the  left 
side  of  the  tongue)  and  press  the  soft,  projecting 
compound  under  the  edge  of  the  tray,  and  back 
behind  it,  onto  the  condyle,  and  on  the  outside 
of  it,  over  the  masseter  muscle — ^well,  all  around 
the  condyle  lightly. 

Now,  change  hands,  and  in  exactly  the  same 
way  do  exacth^  likewise  on  the  left  side.  Get 
this  all  clear  in  mind;  then  we  '11  go  ahead. 
(Some  one  of  the  class  is  asked  to  explain  this 
far;   then  we  resume.) 

I  '11  now  hold  the  impression  down  with  my 
two  index  fingers,  one  on  each  side;  and,  while 
doing  so,  I  '11  straddle  the  cheek=lips  (on  both 
sides  of  the  mouth)  so  as  to  get  the  cheek  be- 
tween m}^  index  finger  and  my  long  next,  "mid- 
dle," one. 

Observe  closely:  my  first  fingers  are  on  the 
inside  of  the  mouth,  holding  down  the  tray,  and 
my  second  fingers  are  on  the  outside  thereof. 
While  I  work  down  on  the  cheek,  outside,  with 
my  long  fingers,  I  also  at  the  same  time  work 
down  the  outside  of  the  under=lip,  in  front, 
with  my  thumbs.  Wh}^  it  seems  as  though 
our  hands  and  fingers  were  made  on  purpose 
to  take  a  lower  impression  in  this  simple,  easy 
"Greene "  wa}^ 

Now,  my  impression  is  pressed  down  to  place 
all  around,  on  both  inner  and  outer  sides  of  the 
alveolar  ridge,  and  also  at  the  heels.  But  it 
presses  too  hard,  probabl}^  on  the  active  mus- 
cles, especially  the  masseters. 


IN  Dental  Prosthesis.  103 

And  now,  here,  doctors,  is  a  pointer  of  great 
A^alue  to  any  extensive  plate=maker.  With  my 
front  finger  still  holding  the  impression  down, 
and  the  modeling  compound  still  warm,  I  say: 
"Madam,  open  and  close  your  mouth  and  bite 
down  on  my  fingers,  quickly.''  As  I  give  her 
the  command,  I  look  her  in  the  face  and  kind 
o'  obe}'^  it  m3"self,  to  prompt  her  movement. 

When  she  opens  and  closes  her  mouth  and 
bites  on  my  finger,  the  muscles  aforesaid  lift 
the  material,  projecting  beyond  the  mictal  tra}^ 
up  enough  to  give  full  relief  from  maximum 
strain,  but  no  more.  The  contact  is  still  near 
enough  that  the  little  space  between  the  lifted 
compound  and  the  flesh  (maximum  and  min- 
imum range  of  play)  will  fill  up  with  saliva,  and 
thus  make  conditions  for  atmospheric  pressure, 
or  so=called  "suction." 

After  she  has  obeyed  m}-"  command  and  the 
strain  is  lifted  from  the  masseters  and  condyles, 
with  m}^  fingers  still  on  down=holding  duty,  I 
have  her  also  work  her  lip  and  cheeks  a  little, 
to  approximately  relieve,  maybe,  other  strained 
tissues;    especialh'  the  levator  labii  inferioris. 

Then  I  give  her  another  command  (for  which 
she  has  previously  been  prepared,  and  instruct- 
ed to  obey  it) :  Madam,  now  squirt  your  cold 
water  into  your  mouth  quickly!"  This  is  from 
a  little  sA'ringe  in  her  own  hand;  or  in  the  hand 
of  an  assistant,  if  one  is  at  command.  It  is  to 
cool  the  impression. 

After  a  half = minute's  cooling  I  remove  my 
correctable  impression  from  the  mouth;  and 
the  whole  procedure  hasn't  taken  much,  if  any, 
more  than  a  minute  or  two  of  time. 

But  we  '11  look  at  it  now,  and  see  whether 
it  is  really  a  correctable  impression  or  not.  If, 
b}^  some  mishap,  the  metal  edge,  or  other  part 
of  the  tray,  should  show  through,  it  'd  not  be 


104  Greene  Brothers'  Ceinicai,  Course 

a  correctable  impression.  The  movements  of 
the  muscles  can't  correct  metal. 

So,  if  any  metal  is  in  sight,  we  '11  just  cut 
it  all  away  with  knife  or  file  sufficiently,  and 
trace  compound  thereon  to;  then  it  will  be  cor- 
rectable, by  muscle= trimming. 

Well,  we  now  have  about  what  we  'd  have 
had  by  the  student's  method,  plus  the  approx- 
imate relief  of  masse ters,  just  described.  In 
either  case,  we  are  now  ready  to  proceed  to 
correct  what,  after  all,  is  so  far  only  a  model- 
ing=compound  tray.  The  correction  will  be  the 
transformation  of  this  tray,  by  detail,  into  a 
test=impression. 

You  have  now  seen  done  and  heard  ex- 
plained the  first  step  in  a  full  lower  modeling= 
compound  impression.  To  further  impress  it 
on  your  minds,  some  one  of  you  may  now  read 
it  as  "Step  No.  i,"  on  this  list  of  printed  notes, 
that  each  one  of  the  class  is  to  keep  for  future 
reference.  (Later:  This  ^fiw^^(i  work  will  now, 
of  course,  supersede  the  former  note  system  for 
reference.) 

Step  No.  2  in  Lower  Impression. 

' '  Trim  it  approximately  with  knife,  leaving 
it  a  little  too  long,  and  fully  deep.'' 

This  consists  simply  of  the  warming  of  the 
edges  a  little  over  the  spiritdamp  and  shaving 
off,  with  a  sharp  knife,  what  is  evidently  a 
surplus. 

Bear  in  mind,  this  knife=trimming  is  only 
a  crude  approximation;  but  about  such  as  dent- 
ists usualh^  depend  on  for  exactness  in  the  com- 
mon, old  method  of  guess=trimming  of  plates. 

Well,  now  that  our  correctable  im.pression 
is  only  a  very  little  larger  than  the  finished 
plate  is  to  be,  and  will  not  distort  the  mouth 
by  its  size,  or  depth,  or  length,  we  are  ready 


IN  Dental  Prosthesis.  105 

to  correct  its  center  over  the  alveolar  ridge; 
or  where  the  ridge  used  to  be,  if  absorbed. 

It  may  really  be  correct  there  now,  but  we 
don't  know  it;  for  it  covered  more  area  than 
we  needed,  and  that  may  have  strained  and 
distorted  wdiat  we  do  need.  So  we  '11  go  through 
the  motion,  and  no  harm  will  be  done,  anyhow. 

Step  No.  3  in  Lower  Impression. 

"Equalize  the  center  by  hot  =  stream,  normal 
plate= pressure,  and  wave=like  motion^ 

We  '11  pour  our  six=penny  hot=stream  from 
our  little  spout = cut  into  its  center  till  it  is  quite 
soft — just  on  the  safe  side  of  the  buming=point. 
This  softens  the  center  well  and  deeply. 

Then  instantly  we  dip  the  whole  thing  into 
hot  water  and  out  quickly,  to  mellow  the  edges  a 
little,  but  very  shallowly.  Then  dextrously,  but 
carefully,  return  it  into  the  mouth  (left  side  of 
mouth  first)  and  as  quickly  wave=press  down 
with  our  two  index  fingers  lightly. 

We  hold  it  down  half  a  minute,  when,  more 
than  nine  chances  to  one,  the  pressure  is  equal- 
ized; if,  indeed,  it  needed  equalizing.  But  do 
this  properly  a  second  tim.e,  and  it  is  sure  to 
be — ^Vv'hich  is  to  be  test=proven  a  little  later  on. 

Of  course  all  this  has  to  be  done  quickly, 
or  it  will  be  a  failure.  It  may  take  some  prac- 
tice for  some  of  you  to  do  it  quickl}^  enough 
for  success.  As  in  writing,  you  first  learn  how 
to  perform  these  little  manipulations  and  then 
how^  to  do  it  speedily. 

One  "D.D.S.,"  with  a  sigh,  once  upon  a  time 
voluntarily  admitted  he  "wa'n't  fitten  by  na- 
tur  to  do  sich  fine  work  and  so  quick."  lie  'd 
"ruther  practus  his  specialty  an'  pull  an'  plug 
teeth  an'  do  crown=  an'  bridge=work." 

Well,  now,  you  may  read  your  note  again, 


106  Greenk  Brothers'  Clinical  Course 

as  before,  what  you  have  seen  done  and  heard 
explained,  as  the  third  step. 

I  '11  only  add  that,  if  we  took  our  correct- 
able impression  by  the  practitioner's  method, 
and  carefully,  it  isn't  probable  any  change  has 
been  made  as  to  the  fit  by  this  equalizing  step. 
But,  if  any  at  all,  it  isn't  probably  more  than 
the  thickness  of  the  thinnest  blotting=paper,  at 
the  m.ost.  An  expert  can  do  this  by  quick  hot= 
dipping  the  Vvhole  impression,  instead  of  spout= 
cup  pouring. 

Step  No.  4  in  Lower  Impression. 

* '  Bite  on  dummies,  for  jaw=rest. ' ' 

We  Vvill  now  prepare  to  very=edge  the  outer 
rim  of  our  imipression.  As  before,  this  muscle= 
trimming  is  done,  again,  by  lip=and=cheek  and 
tongue  movement,  on  sensitized  surfaces. 

To  very=edge  correctly,  and  hence  success- 
fully, the  impression  must  surely  be  held  down 
to  place  while  the  muscles  do  their  trimming. 
This  is  absolutely  essential;  so  we  must  plan 
to  hold  it  down.  And  it  must  be  down  with- 
out our  own,  or  our  patient's,  finger=help;  for 
that  would  interfere  with  the  normal  action  of 
the  moving  tissues  that  do  the  trimming.  In- 
deed, the  patient  wouldn't  make  the  necessary 
movement  with  my  finger  in  her  mouth. 

So  we  '11  put  a  jaw=rest  on  the  reverse  side 
of  the  metal  tray  for  her  to  bite  down  onto, 
while  she  makes  the  scientific,  automatic,  self= 
trimming  movements. 

See!  I  will  take  this  little  roll  of  warm 
compound,  about  three =fourths  of  an  inch  long, 
heat  its  surface  on  one  side  a  little,  and  stick 
it  onto  my  metal  tray — the  other  side  from 
the  impression.  I  '11  put  one  on  each  side,  of 
course.  They  are  "dummies."  I  '11  warm  the 
edges  of  my  dummies. 


IN  Dental  Prosthesis.  107 

"Now,  Madam:  When  I  put  this  into  your 
mouth,  I  want  you  to  bite  do\\TL  onto  it  auick- 
ly.''  She  gives  one  snap  and  my  dummies  have 
the  marks  of  the  upper  teeth  (or  her  gums,  if 
she  has  no  teeth)  on  them.  That  is,  we  have 
had  her  ' '  bite  on  dummies  for  jaw=rest. 

So  you  now  read  "Step  No.  4,"  after  you  've 
seen  it  done  or  heard  it  all  explained  in  detail. 

Step  No.  5  in  Lower  Impression. 

"  Very=edge  {muscle=triin)  oviter  rim  and  heels, 
one  side  at  a  time,  by  sivallowing  and  lip=and= 
cheek  movements,  while  biting  down  on  dummies.'' 

I  will,  for  instance,  very=edge  on  the  left 
side  of  her  face  first.  I  '11  warm  the  very  edge 
of  what  is  the  right  wing  of  the  impression 
when  the  handle  points  toward  me,  and  slip 
the  opposite  left  wing  (not  w^armed)  into  her 
mouth  first;  then  pull  her  left  cheek  over  to 
her  leftward,  and  enter  the  warmed  edge  last, 
without  cheek  interference. 

Immediately  she  bites  down  onto  the  jaw= 
rest  (dummy)  and  swallows,  and  sucks  her 
cheeks  and  works  them  energetically.  In  from 
fifteen  to  thirty  seconds  I  have  the  outer  side 
of  my  impression  accurately  trimmed,  and  also 
cut  off — or,  rather,  turned  up — for  the  right 
length  at  rear. 

The  deglutitory  motion  did  the  up=tuming 
for  the  length  of  the  coming  plate.  And  it  will 
be  just  this  long,  because  the  model  from  our 
up=tumed  heel  will  make  it  just  so.  The  length 
of  a  lower  plate,  same  as  that  of  an  upper  one, 
may  be  of  exceeding  importance. 

But,  lest  this  first  trimming  ma}^  possibly 
not  be  all  that  is  needed,  I  '11  repeat  it  till  no 
further  show  is  made  by  the  cheek  and  swal- 
lowing movements.  Do  this  righth',  and  your 
trimming  will  be  exactly  correct. 


108  Greene  Brothers'  Clinical  Course 

Now,  I  '11  similarly  warm  the  other  side  and 
oppositely  enter  it,  and  have  the  same  move- 
ment made  as  before.  And,  if  necessary,  I  '11 
make  a  special  trip  into  the  mouth  to  partic- 
tilarly  muscle=trim  the  lower  lip=strain  by  the 
movement  of  the  levator  labii  inferioris — in  Latin 
for  short! 

You  well  know  how  commonly  this  levator 
breeds  the  Johnny =jump=up  malady  in  lower 
dentures.  But  this  pesky  lever  is  a  wise  me- 
chanical surgeon;  it  knows  just  where  to  trim 
a  modeling=compound  impression,  or  plate,  if  it 
has  a  chance. 

Well,  we  are  done  with  the  outer  rim;  let  's 
get  to  the  inner  one. 

Step  No.  6  in  Lower  Impression. 

In  the  language  of  ^-^our  printed  note,  let  us 
' '  Very  =  edge  the  inner  rim  and  inner  heels, 
all  around  at  once,  by  swallowing  and  by  vig- 
orous tongue  movements,   while  biting  down  on 
dummies.'' 

Since  we  are  getting  onto  our  job  of  sci- 
entific trimming,  this  is  easy. 

I  will  this  time  warm  the  inner,  or  lingual, 
rim,  and  all  around  at  the  same  time.  But,  as 
the  muscles  and  glands  under  the  tongue,  that 
are  to  do  the  mechanical  surgery,  are  often  very 
lax  and  soft  and  weak,  we  must  now  have  our 
inner  rim  quite  soft  indeed — just  a  few  degrees 
on  the  cooler  side  of  the  scorching=point,  in 
some  cases. 

After  blistering  your  own  mouth,  and  es- 
pecially that  of  your  patient  mother=in=law  a 
few  times,  you  '11  leam  to  make  this  fine  line 
of  thermal  demarkation  to  an  amazing  nicety. 
(Don't  shudder  at  this  prospect  of  vivisection 
in  the  interest  of  prosthetic  dental  science.) 

You  must  leam  to  muscle=trim  the  lingual 


IN  Dental  Prosthesis.  109 

rim  so  it  will  safely  set  down,  without  strain,  in- 
to the  sub=lingual  saliva  pool,  to  give  it  suction. 

To  my  patient:  "Listen,  Madam,  to  what 
I  'm  going  to  say.  The  instant  I  slip  this  edge=» 
warmed  impression  into  your  mouth,  I  want 
you  to  bite  down  on  our  dummies  and  swallow, 
and  throw  your  tongue  all  over  your  mouth  as 
vigorously  as  you  can.  Act  quickly  and  fast! " 
(Better,  in  some  cases,  practice  Madam  a  little, 
in  advance,  in  the  movement.) 

She  has  obeyed;  we  '11  leave  the  impression 
in  a  few  seconds,  to  cool,  and  then  take  it  out 
and  knife=trim  off  the  tumed=up  edge,  or  a  part 
of  it.  We  11  use  common  sense  and  simply 
repeat  what  we  have  done  till  no  more  sur- 
plus turns  up-  by  the  same  energetic  action; 
then  we  '11  have  an  accuracy  of  trimming  not 
to  be  reached  in  an  hour,  or  a  day,  of  trials  by 
guess= trimming  off  a  plate  after  it  's  made. 

You  say:  "All  this  is  mighty  particular 
work."  Of  course  it  is;  but,  after  all,  not  more 
so  than  many  other  things  you  have  been  do- 
ing. Nor  is  it  as  particular  as  what  your  wife 
has  often  to  do  when  she  picks  the  naughty 
motes  from  your  eyes. 

Can  you  afford  to  be  as  skillful  and  as  art- 
istic in  your  boasted  professional  manipulation 
as  your  chiropodistic  artist  has  to  be?  If  not, 
better  turn  3^our  impression= taking  over  to  him. 
He  is  used  to  being  "particular"  in  his  work. 
But,  seriously,  it  will  not  seem  to  be  so  when 
you  get  accustomed  to  it. 

Step  No.  7  in  Lower  Impression. 

''Conform  lingual  side  by  steady  to ngue= press- 
tire,  and  cool  well  in  place,  with  syringe,  through 
notch,  while  biting  down  on  dummies.'' 

By  conforming,  you  know,  we^mean  warm- 
ing slightly  and  pushing  to  place  with  steady, 


110  Greene;  Brothers'  Ceinicae  Course 

gentle  pressure,  and  cooling  while  under  such 
pressure.  To  press=to  and  then  remove  and  let 
the  material  rebound  wouldn't  be  conforming 
worth  a  penny. 

It  must  be  at  least  fairly  well  chilled  while 
in  place,  under  gentle  strain,  and  then  well 
cooled  before  removal.  Don't  tire  of  this  repe- 
tition;   you  '11  "need  it  in  your  business. " 

But  let  us  go  on  and  conform  these  lingual 
sides  of  our  impression.  In  our  sub  =  lingual 
very=edging  we  prevented  air  from  passing  in 
and  out  under  the  lingual  edge,  by  its  reaching 
onto  and  into  the  sublingual  saliva  pond.  But 
there  is  room  for  some,  and  is  already  some, 
behind  it.  So  we  must  get  that  out;  or,  rather, 
we  must  have  our  patient  do  it. 

Before  we  put  her  at  it,  we  '11  ctit  a  little 
notch  in  the  dummy,  on  the  left  side  of  her 
face,  so  we  can  squirt  some  cold  water  under 
her  tongue,  through  our  syringe  point,  to  cool 
the  compound,  while  under  pressure. 

I  repeat:  "  A'ow,  Madam,  listen  to  what  I  'm 
going  to  ask  you  to  do.  As  soon  as  I  place  this 
into  your  mouth,  I  want  you  to  push  it  up 
close  against  your  gums  with  you  tongue,  using 
gentle,  steady  pressure.  Push  all  around  and 
hold  it  to  place  till  I  can  squirt  some  cold  wa- 
ter through  this  notch  and  thoroughly  cool  it." 

This  she  will  easily  and  readily  do.  Her  soft 
tongue  will  give  an  even,  equalized  pressure  on 
the  harder  and  the  softer  parts,  nearly  the  same. 

I  will  here  remind  you  that  we  are  now  tak- 
ing this  part,  as  we  have  taken  all  other  parts, 
at  about  right=angle  pressure;  which  is  almost 
essential  in   modeling=  compound  manipulation. 

Plaster  of  Paris  (by  the  "pass=word  method" 
only)  pushes  in  all  directions  alike,  and  thereby 
equalizes.  But  modeling  composition — the  best 
of  it- — hasn't  much  flowing  quality,  at  a  suffer- 


IN  Dental  Prosthesis.  Ill 

able  temperature;  therefore  it  must  be  pressed 
at  right  angle  against  the  soft  places,  which 
yield  according  to  their  needs. 

All  right;  -we  've  now  so  pressed  the  lingual 
side  of  our  impression  and  cooled  it  through 
the  prepared  notch.  Now,  we  have  valve= 
pressure  on  all  the  soft  parts,  so  air  can  not 
pass,  unless  our  impression  (or  plate)  is  moved 
by  force;  and  this  common  force  has  been 
prevented  by  muscle=trimming. 

We  have  here  done  a  most  important  thing 
in  making  a  lower  plate— conformed  it  to  the 
lingual  side  of  the  alveolar  ridge,  assuming  it 
has  a  ridge. 

Step  No.  8  in  Lower  Impression. 

''Take  impression  of  frcFmim  by  quick  lip= 
licking,  and  re=touch  while  holding  down  with  both 
index  fingers.  Don't  bear  hard  nor  press  down- 
ward when  re=tottching.'' 

Just  before  warming  the  spot  of  frsenum 
contact  on  the  lingual  rim  of  my  impression, 
at  the  side  of  my  small  spirit= flame,  or  with  my 
mouth  blow=pipe,  I  say:  "Mrs.  Jones,  I  'm  go- 
ing to  hold  this  impression  down  myself  this 
time,  with  my  forefingers,  so  you  can  use  your 
tongue  quickly  and  freel3^  Immediately  on  this 
going  back  into  your  mouth,  you  will  please 
lick  up  under  your  upper  lip  vigorously,  and 
quickly  draw  your  tongue  back  to  its  place." 

In  doing  this,  when  the  material  is  quite 
soft,  she  simply  muscle = trims  out  room  for  the 
frsenum  to  move  freely  in,  when  she  licks  her 
lips,  in  wearing  the  plate.  For,  of  course,  again, 
the  plate  is  to  be  a  duplicate  of  the  impression. 

But,  as  she  may  trim  out  a  little  too  fnuch, 
so  as  to  leave  a  little  leak  (at  the  sides  of  the 
fraenum),  I  hurriedly  dip  my  finger  in  cold  wa- 
ter, and  reach  over  under  her  tongue,  and  gen- 


112  Greene  Brothers'  Clinical  Course 

tly  pull,,  back  what  may  have  been  overdone 
by  the  muscle"  itself  under  too  vigorous  tongue 
movement.  She  mustn't  loll  her  tongue  otit, 
lest  she  frsenumizes  too  deeply  and  gives  relief 
with  a  leak. 

I  will  here  give  you  each  a  sample  retouch 
in  your  own  mouths,  using  a  different  finger, 
of  course,  in  each  case.  You  feel  my  finger 
pressure  is  light,  but  steady  and  not  downward. 

Should  you  use  much  force  in  retouching, 
you  'd  undo  what  you  've  aimed  to  do.  You 
merely  need  to  pull  back  to  place  a  "leetle" 
compound  that  may  have  been  pushed  off  from 
the  ridge  at  the  sides  of  the  fra:num,  so'  as  to 
stop  the  air=leak. 

Step  No.  9  in  Lower  Impression. 

Here  is  your  note: 

' '  Test  for  fit.  Dip  the  impression  in  cold  wa- 
ter; place  it  in  the  mouth;  and  hear  down  with 
index  fingers  firmly  for  half  a  minute.  If  it 
sucks  fast,  or  even  if  it  comes  loose  with  a  little 
noise,  it  's  0.  K . — not  otherwise.  If  no  blunders 
are  made  in  following  up  all  after=work,  the  plate, 
after  it  settles,  will  always  fit  even  better  than  the 
impression  tests." 

Any  perfect  impression,  on  a  ridge  of  almost 
any  size,  will  have  more  or  less  so=called  suc- 
tion after  pressed  down  a  little  while.  And  any 
impression  ought  to  have  a  little  of  such,  though 
not  always  enough  to  hold  it  down  much. 

Nor  is  it  at  all  essential  that  a  lower  plate 
should  have  strong  suction.  Even  though  it 
should  stick  tightly  (as  most  of  them  will  for 
a  while),  the  tissues  will,  in  time,  be  absorbed 
and  the  plate  lose  its  down=hold. 

(We  '11  have  a  "Joker"  substitute  for  a  low- 
er suction  before  we  are  done  with  it.) 
5  I ;  i  I    'n   y  test  I  want  at  least  to  hear  the 


IN  Dental  Prosthesis.  113 

impression  make  a  little  "squashy"  noise  in 
working  it  up  and  down,  by  its  short  handle, 
as  proof  that  I  have  a  fit.  If  it  didn't  make 
any  noise,  I  'd  conclude  I  hadn't  the  best  fit 
that  could  be  made.  So  I  'd  set  about  for  an 
improvement. 

:  ^  I  'd  not  take  another  impression,  however. 
If  I  were  to  make  one  hundred  sets  of  teeth, 
I  'd  take  but  one  impression  for  each  case. 
And  I  'd  correct  each  one  till  I  got  my  desired 
test. 

If  this  one  doesn't  test,  I  will  resort  to  Step 
No.  lo. 

Step  No.  10  in  Lower  Impression. 

A  Review  Step. 

This,  if  needed,  would  be  a  review  step.  I 
would  first  try  the  conditions  of  Step  No.  g 
again.  Then,  still  failing,  I  'd  repeat  the  op- 
eration of  No.  7;  then  No.  6;  and  then  No.  5, 
in  turn  (in  their  backward  order),  till  I  foimd 
the  fault  somewhere. 

But  I  'd  look  especially  after  the  masseters 
and  lower=lip  strain;  not  forgetting  the  sub= 
lingual  tissues,  in  case  of  fiat  gums.  But  in 
cases  of  much  alveolar  ridge  I  'd  rather  expect 
to  find  the  defect  in  poor  conforming  of  the 
lingual  edge  of  the  impression  to  this  ridge. 

But,  anyhow,  doctors,  I  'd  not  take  another 
impression;  and  then  another  and  another,  af- 
ter the  old  way.  I  'd  adjust  and  correct  up 
parts  of  the  same  one  in  detail  until  I  got  a 
test  that  would,  in  advance,  warrant  a  fit  of  my 
denture. 

Then  I  would  polish  its  edges,  if  not  its 
entire  surface,  over  a  spirit= flame;  and  go  on 
and  make  a  polished  model  that  would  mold,  or 
swage  me,  a  duplicate,  almost  finished,  denture. 

If  of  plaster,  this  model  is  made,  of  course, 


'114  Greend  Brothers'  Clinicai,  Course 

by  the  ' '  full  saturation ' '  way  of  mixing  and 
pouring.  That  is,  the  correct  quantity  of  pure, 
tepid  water  with  the  right  amount  of  good  plas- 
ter, mixed  quickly  and  "poured,"  or  placed, 
before  it  begins  to  harden. 

To  impress  an  important  point,  I  '11  repeat: 
Stirring  plaster  (or  any  other  crystallizing  sub- 
stance) after  it  has  commenced  to  set  much, 
breaks  the  forming  crystals  and  causes  rotten- 
ness of  the  product. 

•  A  Plaster  Lower  Impression. 

If  for  any  reason,  real,  imaginary,  habitual, 
or  otherwise,  I  should  want  a  plaster  impres- 
sion, I  'd  now  use  this  completed  modelings 
compound  one  as  a  tray  to  take  it  in.  I  'd 
pour  some  very  thin,  creamlike  plaster  (impres- 
sion plaster)  into  it,  sling  it  mostly  out,  and 
take  my  plaster  im.pression  quickly  with  light 
index=finger=pressure  and  wave=motion.  The 
wave=motion  is  to  cause  the  better  flowing  of 
the  plaster. 

If  any  careless  excess  of  plaster  should  over- 
flow the  muscle=trimmed  edges  of  my  compound 
tra}^  I  'd  rub  it  off  before  making  my  model; 
and  use  the  modeling= compound  edges  as  my 
guide,  both  in  pouring,  and  trimming  my  model. 

But,  doctors,  there  would  seldom  be  any 
good  reason  for  the  plaster;  for  I  couldn't  im- 
prove such  an  impression,  even  technically,  un- 
less I  could  confine  it  (the  plaster)  and  employ 
the  conditions  of  the  "pass=word."  (Index  P.) 
Still,  as  it  requires  less  skill  to  equalize  with 
cream=like  plaster  than  with  the  spout=cup,  it 's 
the  best  way  for  a  novice — after  the  fnodeling= 
compound  impression  has  been  otherwise  finished. 

The  making  of  a  model  here  would  be  the 
same  as  in  the  upper  case,  whether  I  used  all 
plaster,  or  my  non=changeable  approximates, 
and  faced  them  with  plaster. 


IN  Dental  Prosthesis.  115 

But  I  'd  make  it,  in  either  case,  immediately 
after  getting  a  satisfactory  test  of  my  impres- 
sion;   or  else  keep  the  impression  in  cold  wa- 
ter till  I  could  make  it.     (Another  point  that  '11 
.  bear  repetition.) 

And  though  "this  is  neither  the  time  nor 
the  place"  to  give  the  valuable  secret,  I  can't 
forbear  to  tell  you  it  is  best  always  to  make 
a  plaster  model  as  thin  as  you  well  can;  or 
at  least  trim  it  down  thin  after  it  is  made. 
Then  use  metal,  or  other  non= changeable  plates 
of  some  sort,  under  it,  when  necessary  to  raise 
it  up  in  the  flask,  in  packing. 

This,  doctors,  is  a  pointer  worthy  of  a  gold= 
plated  safety =pin  in  it.  You  have  doubtless 
spoiled  many  a  case,  as  to  its  fit  and  occlusion, 
one  or  both,  by  putting  worthless,  mxushy  plas- 
ter imder  your  plaster  model,  to  raise  it  in  your 
flask.     Have  you  ever  thought  of  it? 

This  all,  however,  more  properly  comes  up 
in  our  "third  degree,"  when  the  whole  model= 
smashing  matter  will  be  reviewed. 

Partial  Lower  Impressions. 

This  is,  to  some  extent,  a  repetition  of  the 
principles  involved  in  the  full  lower;  but  it 
takes  in  still  more. 

We  will  first  take  a  case  of,  say,  six  re- 
maining anterior  teeth.  I  prefer  a  tray  with 
a  me tal= closed  space,  or  place,  for  the  natural 
teeth  to  project  into;  but  open  ones  can  be 
closed  with  modeling  composition. 

See,  here  is  a  common,  ridiculous,  long= 
handled  one  that  we  '11  trim  up  and  down. 
We  '11  "transmogrify"  it,  as  some  call  my  bold 
surgery  on  the  old=fashioned  trays. 

We  '11  cut  ofl^  the  long  handle  to,  say,  three= 
fourths  of  an  inch  in  length  and  hammer  it 
(the  shortened  handle)  down  thin  to  get  rid 
of  tipping  weight  and  inconvenient  bulk. 


116  Greene  Brothers'  Clinical  Course 

p  f  We  '11  further  trim  down  its  sides  and  cut 
it  off  at  the  rear,  the  same  as  for  a  full  lower; 
and  especialh'  trim  it  off  clear  down  to  the 
handle  in  front.  This  last  in  order  to  take  the 
impression  of  onty  the  ends  of  the  front  natural 
teeth  on  their  outer  surfaces. 

We  '11  want  to  change  this  impression  off= 
and=on;  so  we  want  room  to  look  under  and 
see  the  teeth  properly  re=enter  into  their  re- 
spective sockets  in  the  compound. 

(We  have  recently  perfected  a  set  of  trays, 
including  this  needed  one,  with  removable  han- 
dles ;  manufactured  by  the  Detroit  Dental  Man- 
ufacturing Company,  Detroit,  Mich.) 

As  the  natural  teeth  here  act  as  guides,  to 
prevent  side=slipping,  it  is  even  easier  to  take 
a  partial  impression  than  a  full  one — in  model- 
ing compouTid. 

After  the  tra}"  is  center=fitted  over  the  teeth 
and  alveolar  ridge,  as  in  the  full  case,  we  '11 
take  a  roll  of  material  from  our  hot=water=pan 
and  shape  it  into  place  ("fashion"  it)  in  our 
tray,  as  we  did  before  in  the  full  case. 

We  '11  now  warm  it  over  our  hand=lamp 
flame,  as  in  the  full  case  before.  And  we  '11 
take  this  partial  impression  in  every  respect  as 
before  in  the  full  case,  through  to  the  finish 
of  it. 

All  that  was  shown  you  in  such  detail  as  to 
hardly  need  repeating  in  the  partial  case;  pro- 
vided the  teeth  are  so  shaped  and  stationed  as 
to  let  our  impression  iri=and=out  of  the  mouth 
Without  "drawing."  In  fact,  in  an  eas}^  case 
like  thiS;  it  reqtiires  but  a  very  few  steps  in= 
and=out  to  do  all  I  have  told  and  shown  you. 
And  some  of  it  is  seldom  needed. 

We  are  almost  certain  to  get  a  correct  im- 
pression of  the  alveolar  ridge  every  time.  So 
the  most  there  is  to  it  is  the  muscle=trimming 


IN  Dental  Prosthesis.  117 

for  relief  =  room,  especial!}^  at  and  about  the 
heels;  and  the  conforming  on  the  lingual  side. 
Relief =without=leak — and  the  story  is  told. 

"Yes,  but,"  emphasizes  one  of  you,  "what 
about  leaning  teeth  and  bell=shaped  crowns, 
where  the  compound  mtist  draw,  or  it  '11  not 
come  out?" 

modeling=compound  impressions  with 

Leaning  Teeth  and  Bell= 

Shaped  Crowns. 

Well,  when  we  have  the  right  sort  of  mod- 
eling compound  and  know^  how  to  use  it,  that 
once  vexing  problem  is  easily  solved.  Then  the 
old  bugaboo  vanishes.  Then  it  is  very  much 
easier  to  take  such  an  impression  in  compound 
than  in  plaster;  that  is,  plaster  in  the  old  way. 
The  best  old  way,  however,  is  new  to  a  ma- 
jority of  dentists. 

The  common  old  plaster  way  is  to  take  the 
impression,  teeth  and  all;  remove  the  tray  and 
break  the  plaster  adhering  to  the  teeth  all  into 
uncertain  pieces,  in  the  mouth;  then  take  pieces 
out  and  stick  them  back  together — and  make 
the  model. 

That  is  hard  on  the  patient;  besides,  all  the 
trimming  of  the  plate  afterward  is  by  guess=^ 
work. 

Even  if  using  all  plaster,  I  have  a  decided 
improvement  on  this  old  pull=and=pUvSh  way.. 
I  make  the  plaster  break  easily  and  just  about 
where  I  want  it  to.  I  simlpy  place  lavers  of: 
thin  tin=foil  where  I  want  the  plaster  to  break. 
I  drop  the  little  foil  flakes  in  while  I  'm  filling 
the  tray.  The  foil  will  make  a  seam  in  the 
plaster  just  about  where  I  want  it  to  break 
apart.  Then  a  little  thin  cement,  such  as  we 
use  in  temporary  fillings,  will  imite  the  pieces  of 
our  purposely =broken  impression  to  perfection. 


118  Grcenk  Broth krs'  Clinical  Course 

But  I  can  take  the  impression  of  these  lean- 
ing teeth  and  bell=shaped  crowns  just  as  well 
with  modeling  compound,  and  then  have  the 
benefit  of  my  accurate  muscle=trimming,  which 
is  impossible  with  plaster  by  the  old  way.  But, 
now,  how  to  do  this. 

Coring  Out  for  Under=Cut  Impressions. 

I  first  carefully  press  enough  compound 
around  the  teeth  to  build  them  out  to  cone= 
shape,  instead  of  under=cuts.  Then  I  cool  it 
in  place;  varnish  it  to  hold  tin=foil;  stick  on 
some  foil  and  dtist  it  over  with  powdered  soap- 
stone. 

I  then  treat  these  cored=out  teeth  just  as 
if  they  were  naturally  cone=shaped.  I  go  on 
and  take  my  impression  to  the  finish,  same  as 
in  our  simple  case,  just  described. 

When  my  main  impression  is  m  u  s  c  1  e  = 
trimmed  and  conformed  on*  lingual  side,  and 
out  of  the  mouth,  and  so  forth,  I  cool  my 
cores,  still  in  place  around  the  teeth,  well;  break 
them  away  from  their  places;  take  them  out 
and  put  them  where  they  belong  in  the  main 
impression. 

Then  I  make  my  model,  preferably  using  my 
non=changeable  approximate,  to  provide  against 
changes  in  plaster  and  in  my  dentures  from 
packing,  vulcanizing,  and  cooling. 

"But,"  you  ask,  "how  are  you  going  to  get 
your  plate  into  place,  when  made?"  Well, 
doctors,  that  's  your  job — not  mine. 

I  've  shown  you  how  to  take  your  impres- 
sion simply,  accurately,  and  with  a  minimum 
annoyance  to  your  patient.  If  you  have  a  case 
of  under=reach  where  the  plate  can't  be  entered 
as  a  farmer  enters  his  slide=bars  in  his  gate? 
way,  one  end  at  a  time,  you  '11  have  to  cut 
away  some,   of  course.     But  be  careful  where 


TN  Dental  Prosthesis.  119 

you  cut,  and  cut  away  no  more  than  necessary. 
That  's  all  you  can  do,  that  I  know  of.  Doc- 
tor, just  set  your  brain  machinery  to  harmonize 
with  your  sub  =  conscious  genius,  and  answer 
your  own  question. 

But,  after  all,  doctors,  a  perfectly  fitting 
denture,  rightly  adjusted  to  the  muscles,  doesn't 
need  to  fit  close  against  the  teeth  at  all  points, 
if,  indeed,  at  any  point.  If  strained,  such  teeth 
soon  give  way  for  relief,  anyhow.  So  we  don't 
depend  on  a  fit  against  the  teeth  to  help  hold 
the  plate  very  long.  Such  help  is  beneficial 
only  in  helping  hold  the  plate  in  place  till  it 
adjusts,  or  imbeds,  itself. 

As  for  clasping  the  plate  to  the  natural 
teeth,  I  quit  that  thirty  years  ago  as  unneces- 
sary, when  not  realh'  harmful.  Still  I  concede 
there  are  partial  cases,  where  the  alveolar  ridge 
has  no  up=tum  at  the  rear,  where  the  telescope* 
crown  scheme  is  useful;  that  is,  where  we  put 
on  a  permanent  crown  on  a  natural  tooth  and 
then  attach  a  telescope  crown,  or  band,  to  the 
plate  and  slip  this  latter  crown,  or  ring,  over 
the  first  one.  But  to  cut  down  any  sound  tooth 
to  crown  it  for  any  purpose  should  be  a  last 
resort. 

Also  a  little  extra  weight  is  frequently  a 
good  thing— mainly  to  help  hold  it  down  to 
place  while  it  imbeds  itself  in  soft  tissues.  But 
that  will  come  up  and  be  explained  in  our  third 
lecture.     I  am  now  on  lower  impression. 

If  you  care  to  take  a  plaster  partial  (which 
is  seldom  any  advantage  where  the '  modeling 
compound  is  taken  properly),  you  can  take  it 
on  the  comipound  one,  by  means  similar  to  the 
"pass=word  method"  in  our  first  lecture.  (In- 
dex P.) 

But,  as  there  is  no  way  to  confine  much  of 
the  cream=like  plaster,  the  main  point  in  the 


120  Greene  Brothers'  Clinical  Course 

"pass=word"  scheme  is  wanting;  so  the  "equal- 
izing" (the  onl}^  possible  purpose  of  the  plas- 
ter) will  not  probably  be  much  improved. 

But,  should  you  equalize  with  "cream=like 
plaster  in  ready  flowing  condition,"  rub  the 
overflow,  if  any,  off  of  the  edges  before  making 
the  model.  The  compound  has  been  muscle= 
trimmed,  and  is  adjusted  to  the  movement  of 
the  tissues. 

Old=Time  Improvement  in  All= 
Plaster  Impressions. 

And  should  you,  for  old=habit's  sake,  wish  to 
take  a  full  lower  all=plaster  impression,  let  me 
suggest  how  to  do  it.  But  you  needn't  bother 
about  telling  those  happy  old  "plaster  fiends," 
who  are  sure  they  "already  know"  enough.  I 
know  their  self = satisfaction  well,  for  I  sat  be- 
side them  in  the  old  stage=coach  for  years,  re- 
fusing to  be  unsettled  m3^self . 

Maybe  better  let  'em  enjoy  the  pleasure  of 
the  gambler's  chance  of  hope =and= doubt  that 
always  goes  with  guess=trimming  and  guess= 
scraping  for  relief. 

But,  for  your  more  modem  selves,  use  our 
old-time  improvement  on  the  old,  tissue=straining 
way.  That  is,  we  "transmogrify"  our  metal 
tray  and  fit  it  to  the  mouth,  as  I  have  shown 
you,  to  a  size  no  larger  than  the  plate  is  to 
be.  You,  of  course,  "understand  the  why  of  a 
shallow  tray. 

We  '11  now  bore  some  holes  through  it  to 
clinch  and  hold  the  plaster.  We  '11  trace  a 
table=spoonful  of  soft  plaster  along  on  the  limit- 
ed tray  and  take  impression  by  tremble=pressing 
down  very  lightly  with  our  two  index  fingers. 

We  '11  look  over  into  our  smooth  earthen 
bowl,  and,  when  the  remnant  of  plaster  there- 
in has  just  begun  to  set  a  very  little,  we  '11  tell 


IN  Dental  Prosthesis.  121 

our  patient  to  close  her  motith,  bite  on  our 
fingers  very  lightly,  swallow,  suck  her  lips,  and 
work  her  cheeks  mildly — and  do  it  all  quickly 
and  stop. 

When  she  has  done  as  told,  I  hold  down  the 
impression  steadily  (or,  better,  have  patient 
hold  it  down  with  index  fingers)  till  the  plaster 
is  hard  in  the  cup. 

When  I  take  it  out,  I  '11  find  the  plaster 
cracked  around  the  edges  of  my  tray,  and  lifted 
up  behind  the  back  ends  of  its  wings.  We  '11 
trim  off  to  the  crack,  and  we'll  have  the  most  com- 
plete all=plaster  impression  possible. 

The  moving  tissues  have  cracked  the  sur- 
plus material  at  the  edge  of  my  narrow  tra,y 
and  told  me  ■  about  where  to  trim  it  to  for 
relief. 

We  can  even  approximately  test  this  im- 
proved all=plaster  impression,  provided  we  have 
no  long,  heavy  handle  to  tray  to  tip  it  over. 
To  make  the  test,  we  '11  do  just  as  we  did  a 
while  ago  in  our  modeling=compound  impres- 
sion, in  Step  No.  9,  of  the  full  lower  case  (p.  112). 

Of  course,  it  will  not  stay  down  as  our 
modeling= compound  impression  did,  because  of 
its  imperfect,  file=guess  trimming.  But  it  will 
tell  us  just  about  how  a  plate  from  it  would 
stay  down,  at  the  start,  anyhow.  Of  course, 
it  would  stay  down  better  after  worn  a  while 
for  adjustment. 

To  some  of  our  old  plaster  friends,  this  im- 
provement would  be  worth  only  98  cents,  be- 
cause it  would  disturb  their  pleasures  in  trim- 
ming by  the  old  college=gag  instructions:  '  *  Trim 
till  you  think  you  've  spoiled  it,  and  then  more 
till  you  are  sure  you  've  spoiled  it — and  then 
some." 

And  worse  still,  doctors,  it  would  steal  from 
them  some  of  the  sweets  of  the  guess=gambling 
uncertainty  in  plate=work. 


122  Greene  Brothers'  Clinical  Course 

Yea,  doctors,  yea,  even  this  improvement 
would  rob  some  of  the  "best  men"  of  their 
names  at  the  head  of  journal  articles  advis- 
ing "Only  plaster  for  impressions";  because  it 
would  timely  lead  them  entirely  away  from 
plaster  at  all — in  lower  impressions,  at  least. 

Better  let  'em  go  on  with  their  long,  deep, 
and  long=handled  tra3^s,  and  their  five=pound 
thumb=pressure  that  distorts  the  mouth  all  out 
of  shape,  so  they  can  trim  and  trim,  time  after 
time,  with  gambling=feature  ecstasy.  Then  in 
the  end,  to  dismiss  the  case  with  multi= assur- 
ance to  patients  that  "lower  plates  don't  stay 
down,  nohow\" 

But  as  for  yourselves,  doctors,  practice  these 
things,  first  a  little  in  your  own  "oral  cavi 
ties,"  then  in  the  mouths  of  your  forbearing 
mothers=in=law,  "sisters,  cousins,  and  aunts"; 
and  announce  to  nauseated  humanity  that  you 
don't  need  to  use  plaster  in  mouths  at  all. 

Or,  to  be  "ethical,"  get  your  patients  to 
tell  it  around  as  a  secret  that  you  no  longer 
need  a  half=gill  of  mushy  plaster  in  a  3x3  tray 
to  choke=gag  people,  by  forcing  it  down  their 
throats,  like  cramming  geese  to  fatten  them. 

Doctors,  please  pardon  this  outburst  of  im- 
patience with  these  over=sized  trays;  over=bulk 
of  material;  and  over=strain  in  needlessly  dis- 
gusting patients,  in  taking  impression.  It  's 
worse  than  mal=practice ;  for  mal=practice  may 
have  the  apology  of  selfish  motive. 


IN  Dental  Prosthesis. 


123 


Fig-  IS- 


Fig.  13. — Modeling-compound  impression  as  usually  taken  in 
common  deep  tray.  Plate  from  it  would  have  to  be  guess-trimmed 
to  fit  straining  tissues — difficult  if  even  possible. 

Fig.  14. — Same  tray  cut  down  and  fitted  tojthe  mouth.  Mod- 
eling-compound impression  (same  mouth)  just  as  taken  by  the 
Greene  muscle-trimming  method.    No  trimming  of  plate^after  made. 

Fig.  15. — "Correctable"  (approximate)  modeling-compound 
impression,  taken  from  model,  ready  for  re-taking  and  adjustment 
to  the  mouth.     (Student's  method.) 


[Cuts  represent   three-fourths  of  full-sized   impression.] 


.124  Greene;  Brothers'  Clinical  Course 

To  Refit  a  Vulcanite  Lower  Plate, 
Temporarily. 

You  should  keep  on  hand  a  supply  of  thin 
wafer  sheets  and  various  thicknesses  of  this 
"Perfection"  material.  To  prepare  it,  you 
press  it  out  on  a  smooth,  wet  surface,  prefer- 
ably of  glass  or  marble.  Waim  it  in  a  com- 
mon tin  pan  and  firmly  slide=press  it  out  with 
a  smooth  bottle  or  tumbler,  also  wet.  But  it 
is  now  furnished  by  the  Detroit  Dental  Manu- 
facturing Company,  of  Detroit,  Mich.,  ready 
for  use. 

A  patient  cOmes  to  your  office,  m.aybe  when 
you  are  busy  at  your  chair,  and  insists  that  her 
teeth  be  "tightened,  somehow."  You  say  to 
your  patient  in  the  chair:  "Keep  your  seat 
and  read  this  little  article  in  the  paper,  three 
or  four  minutes,  while  I  refit  the  old  lady's 
plate." 

Seat  the  complainant  in  your  impression= 
chair.  (Maybe  blindfold  her,  too,  lest  she  may 
learn  too  much  about  refitting  plates  herself.) 
Wash  her  plate  clean  with  a  stiff  brush  and  dry 
it  thoroughly.  (This  may  be  the  biggest  sec- 
tion of  the  job.)  Heat  a  thin  wafer  sheet  and 
stick  it  on  till  it  perfectly  adheres  to  her  plate. 
It  must  actually  adhere,  and  not  merely  stick. 
And  it  must  cover  the  entire  surface  of  the 
plate,  too. 

Then  add  another  thickness  onto  the  first. 
You  can't  stick  a  single  thick  piece  tightly 
enough.  When  the  second  piece  adheres  to  the 
first  all  over,  dip  the  plate  into  hot  water  a 
few  seconds  and  have  her  bite  down  into  it 
quickly.     That  is,  to  take  her  own  impression. 

It  may  require  a  second  heating  and  bite= 
down,  when  the  plate  is  refitted — probably  to 
fit  as  well  as  it  ever  did,  possibly  better. 

"Call  again,  Madam,  if  it  loses  its  fit  in  a 


IN  Dental  Prosthesis.  125 

fewf"days  or  weeks.  I  '11  then  have  more  time 
andlwill  refit  it  permanently." 

This  is  a  temporary  refit,  the  like  of  which 
I  've  known  to  continue  for  several  months. 
But  don't  neglect  to  caution  her  not  to  wash 
her  plate  in  hot  water. 

She  ma^^be  returns  in  a  few  days  or  weeks 
and  wants  the  plate  refitted  again.  This  may 
require  only  re=dipping  and  biting  again,  as  be- 
fore; but  you  may  have  to  dry  and  add  an- 
other wafer,  as  before.  Your  judgment  will 
guide  you  in  it. 

To  Refit  a  Vulcanite  Lower  Plate 
Permanently. 

To  do  this,  you  file  the  rim  of  the  old  plate, 
including  its  heels,  off  down  to  w^here  there  is 
no  under=cut  left.  Place  a  wafer  of  compound 
in  it,  and  add  fully  enough  to  restore  the  miss- 
ing rim  and  heels.  The  material  for  restoring 
the  filed=off  rim  may  be  traced=on,  as  hereto- 
fore shown. 

Now  dip  the  whole  thing  into  hot  water, 
for  an  instant  only,  and  have  her  take  her  own 
impression  by  biting  lightly  into  the  old  plate. 
As  this  is  to  be  a  permanent  refit,  better  soften 
and  bite  twice  to  make  sure  of  a  correct  im- 
pression. The  second  time  you  '11  re=heat  by 
hot  stream  from  your  spout = cup. 

Now  you  have  your  impression  in  the  old 
plate.  Go  on  and  very=edge  the  outer  rim,  and 
then  the  inner  rim;  and  then  conform  the  lin- 
gual rim;  and  then  take  the  impression  of  the 
frasnum  with  essential  quickness.  In  short,  do 
it  all  just  the  same  as  I  've  shown  you  in  case 
of  a  regular  lower  impression,  only  she  takes 
her  own  impression  by  biting  down. 

In  case  you  need  to  lengthen  the  lower  teeth 
{i.  e.,  open  the  bite),  you  simply  use  a  thicker 


126  Greene;  Brothers'  Ceinicae  Course 

sheet  of  compound.  And,  while  it  is  warm, 
have  patient  bite  down,  slowly  and  lightly,  till 
the  teeth  show,  or  the  features  show,  just  as 
you  want  them  to. 

Of  course,  if  the  teeth  need  changing  in 
their  position,  that  must  be  done  first  of  all. 
(See  "Refitting  Upper  Plate"  in  first  lecture.) 

You  have  now  tested  your  fit  and  in  all  re- 
spects have  fashioned  your  denture  to  suit  you. 
Flask  your  case,  teeth=points  downward.  But 
(to  repeat)  don't  put  rotten  plaster  under  it  to 
raise  it  up  in  the  flask.  If  it  needs  raising,  use 
some  non  =  changeable  substance,  like  metal, 
crockery,  or  glass,  to  avoid  mashing,  which 
might  change  your  articulation. 

Trim  off  and  varnish  your  plaster  invest- 
ment, or  bedding,  as  usual. 

Fit  the  metal  edges  of  your  flask  together, 
so  there  will  be  no'  tipping  nor  rocking.  This 
is  to  avoid  change  in  articulation,  or  occlusion. 

Now  fill  your  "double"  flask;  the  impres- 
sion first,  and  carefully,  to  avoid  air= bubbles; 
seeing  there  's  no  water  in  the  impression,  too. 

If  you  use  a  Greene  non=changeable  model, 
insert  it  in  the  impression  according  to  direc- 
tion for  their  use,  before  filling  the  full  flask. 

When  the  plaster  in  the  flask  is  hard,  warm 
the  case  slightly  over  dry  heat,  and  open — at 
the  heels,  of  course,  first. 

If  you  have  properly  soaped  the  impression 
and  it  was  dry  w^hen  you  poured  the  model, 
the  latter  will  come  out  whole  and  smooth. 
But,  should  it  break,  just  mend  it  with  any 
tooth=filling  cement  and  go  ahead,  as  soon  as 
the  cement  is  hard. 

Never,  I  say  again  and  again,  vulcanize 
against  plaster.  But  cover  your  model  with 
tin=foil,  or  other  metal,  or  with  liquid  silex, 
diluted  with  water,  about  half=and=half;  then 
smooth  it  with  soapstone  powder. 


IN  Dental  Prosthesis.  127 

If  yoti  have  provided  small  vents  for  the 
escape  of  a  possible  little  bit  of  surplus  vul- 
canite, your  niodel=holding  half  of  the  flask  (at 
your  right)  is  ready  for  use. 

Now  turn  to  the  plate=holding  half  in  front 
of  you;  warm  it  slightly  and  remove  from  the 
old  plate  everything  and  all  that  constituted 
the  impression.  Then  scrape  for  a  new,  clean 
exposure,  all  over  the  plate's  surface.  Note  the 
direction,  "a//  over.'' 

Pack  evenly;  flask  with  little  strain;  vul- 
canize properly;  cool  slowly  and  thoroughly; 
then  take  out  your  almost  finished  work. 

There  are  other  ways  of  refitting  plates,  but 
none  that  embrace  the  Greene  muscle = trimming, 
valve=edge=fitting,  and  the  like.  They  all  have 
their  defects  and  their  objections. 

The  impression  =  paste  methods,  the  latest 
fads,  are  quick,  but  faulty  and  very  incom- 
plete withal.  They  are  faulty,  in  that  they 
don't  take  equalized  impressions,  even  as  far 
as  they  reach.  They  are  incomplete  in  that 
they  don't  extend  the  plate  at  any  point  and 
thus  don't  refit,  where  lies  nine=tenths  of  the 
lacking.  Nor  in  lower  cases  do  they  even  en- 
able the  widening  of  the  bite  and  lengthening 
of  the  teeth,  so  often  needed  after  alveolar 
absoi-ption. 

Their  only  advantage  is  a  little  saving  of 
time,  provided  we  wanted  to  cover  only  their 
limited  application,  with  incomplete  results. 
Their  application  is  limited  to  only  kind  o'  re- 
fitting the  main  contact  surfaces  of  vulcanite 
plate.  Why  not  refit  it  all,  and,  if  necessary, 
extend  its  area  while  at  it? 

I  say  this  with  regret,  for  I  'd  slop  clear 
over  with  congratulations  at  the  feet  of  the  in- 
ventor of  any  vulcanizable  preparation  that  'd 
enable  the  taking  of  a  complete  test  impression 


128  Greene  Brothers'  Clinical  Course 

in  an  old  plate.  But  so  far  that  has  not  been 
even  approximated — ^nor  even  attempted,  as 
far  as  I  know. 

But,  after  all,  why  refit  more  than  tempor- 
arily at  allf  It  takes  but  a  very  few  minutes 
more  time,  and  a  few  more  cents  expense,  to 
duplicate  anew  the  plate  wholly,  than  to  refit 
it  properly  and  permanently.  And  as  for  the 
fee,  you  can  always  get  a  few  more  dollars  for 
the  few  minutes  extra  time  and  the  few  cents 
extra  expense,  for  the  all=new  material. 

After  you  have  your  contract  to  refit  the 
old  plate  and  have  begun  your  work  to  hold 
your  patient,  honestly  inform  her  that  re=vul- 
canizing  always  deteriorates  and  weakens  old 
plates.  And  that  it  would  cost  her  but  a  little 
more  to  use  all=new  material,  which  you  can 
warrant  not  to  break. 

Indeed,  if  your  fee  is  at  all  fair  to  your- 
self, you  can  afford,  in  selfish  interest,  to  use 
use  all=new  material,  anyhow.  iVad  here  's  the 
way  to  do  it: 

Renewal  of  Rubber  Lower  Plates 
FROM  Old  Ones. 

We  proceed  in  all  steps  just  as  we  do  in 
permanent  refitting,  clear  up  to  the  time  we 
begin  to  clean  out  the  old  plate  for  packing 
in  the  vulcanite. 

Then  and  there,  instead  of  removing  the 
impression  material  and  scraping  out  a  new 
surface  for  the  refit=packing,  we  heat  the  case 
hot,  over  a  dry  flame — a  gasoline  stove,  for  in- 
stance. When  hot,  we  take  a  suitable  instru- 
ment and,  beginning  at  the  heel,  lift  it  all  out; 
the  old  plate,  teeth  and  all,  together. 

Some  of  the  plaster  investment  around  the 
teeth  will  flake  loose;  but  we  '11  quickly  ce- 
ment the  pieces  back  into  their  places,  and  for- 


IN  Dental  Prosthesis.  129 

get  them.  Then  we  '11  oil  the  teeth  and  re- 
move them  from  the  old  plate,  as  in  the  tipper 
case,  before  described.  (Index  R.)  Then  care- 
fully replace  them  back  home.  In  rare  cases, 
we  may  need  to  cement  the  teeth  back  into 
their  places  in  their  imbedment,  to  hold  them 
while  packing  around  them. 

Now  we  '11  cover  the  model,  and  all  other 
plaster  exposed,  with  tin=foil  (No.  4),  thin  silex, 
or  collodion,  and  pack  and  vulcanize  just  the 
same  as  if  we  were  making  an  original,  new 
plate.  In  fact,  when  done,  we  have  made  an 
entire  new  plate,  in  connection  with  the  old 
teeth.  And  we  've  done  it  in  far  less  time, 
and  with  far  less  work,  and  also  much  less  an- 
noyance to  the  patient,  than  to  have  made  it 
over  by  the  usual  method. 

The  right  amount  of  rubber  can  be  prac- 
tically ascertained  in  different  ways;  as  by  the 
usual  ways  of  weighing,  or  measuring  in  water. 
But  a  simpler  way  is  to  take  the  base=plate  (or 
impression  material  in  refit  and  renewal  cases) 
and  roll  it  out  into  a  sheet  the  thickness  of  the 
vulcanite  sheet  we  are  going  to  use.  Then  lay 
the  sheet  of  base=plate  (in  this  case,  modeling 
compound)  down  onto  the  vulcanite  sheet  and 
scribe  it,  and  cut  off  to  the  scratch. 

Then  cut  the  vulcanite  into  suitable  pieces 
and  add,  say,  4  per  cent  extra;  and  go  on  and 
pack  into  place. 

But,  as  guess=work  is  especially  unreliable 
and  objectionable  in  lower  cases,  it  's  best  to 
use  the  cloth,  as  described  in  our  first  lecture. 
(Index  C.) 

Of  course  we  '11  not  tin=foil  the  model  until 
after  the  cloth  has  been  used  and  dispensed 
with.  But  during  the  use  of  the  cloth  (which 
should  still  retain  some  of  its  starch)  the  model 
should  be  treated  to  powdered  soapstone,  well 


130  Gre;e;ns  Brothers'  Cunical  Course 

rubbed  on,  to  prevent  adhesion  of  the  vulcanite 
to  it. 

The  tin=foil  on  the  plate  after  vulcanizing 
is  readily  removed  with  mercurial  paste.  (In- 
dex M.) 

Bear  in  mind  that  in  thus  renewing  plates 
you  can  correct  any  fault  that  existed  in  the 
old  dentures. 

Weight  in  Lower  Dentures. 

You  have  asked  about  the  weight  of  lower 
plates,  weighted  iTibber,  etc.  Well,  in  some 
special  cases,  limited  weight  is  a  mighty  good 
thing,  though  hobby=riding  and  over=doing  have 
brought  the  practice  into  less  than  former  use. 

If  I  were  taking  impressions  and  using  plas- 
ter models  and  making  plates  generally  by  the 
old  ways,  I  'd  still  do  as  I  used  to  do:  weight 
down  a  good  many  of  them. 

But  now,  by  the  new  method,  it  is  far  less 
frequently  needed;  the  weight  being  mostly  to 
hold  the  plate  down  till  the  floating  tissues  ad- 
just themselves  to  it.  No  use  to  try  to  weight 
against  straining  muscles. 

While  I  have  other  means  than  weight  to 
use  instead  thereof,  which  I  11  give  you  later 
on,  I  '11  now  proceed  to  show  3^ou  how  I  weight 
down  a  rubber  plate  to  the  exact  amount,  and 
at  the  exact  place,  I  may  want  it. 

To  Shot=Weight  an  Old  Plate. 

To  do  this,  we  '11  go  back  to  our  refitted 
plate.  When  we  get  ready  to  pack,  we  '11  stop 
and  take  an  engine = bur  and  cut  out  all  but  a 
mere  shell  of  the  rear  half  of  each  wing  of  the 
plate  that  we  are  refitting.  This  is  to  be  filled 
with  the  finest  " mustard=seed"  or  "dust"  shot. 

To  prevent  the  shot  from  running  out,  we  '11 
place  across  the  back  end  of  this  excavation  a 


IN  Dental  Prosthesis.  131 

piece  of  rubber,  preferably  weighted  rubber; 
then  pour  in  the  shot  till  nearly  full.  Over 
this  bird  =  shot  we  '11  place  another  piece  of 
weighted  rubber;  then  go  on  and  sqeeze  to- 
gether, vulcanize  and  finish  as  usual. 

When  taken  out  of  the  flask,  we  '11  have  a 
refitted  and  weighted  plate,  all  finished  but  a 
little  -final  polishing;  which  we  '11  quickly  do, 
while  rejoicing  over  the  knowledge  of  our  new, 
simple,  practical  weighting  scheme. 

To  Shot=Weight  a  New  Plate. 

Having  thus  shot=weighted  an  old  plate,  now 
let  's  weight  a  new  one,  similarly.  We  're  ready 
to  pack  our  case.  We  '11  take  a  little  strip  of 
weighted  rubber  and  wrap  it  around  a  goose= 
quill,  or  some  other  small,  tapering  thing,  and 
knit  the  rubber  edges  together,  so  as  to  have 
a  weigh ted=rubber  tube,  when  we  slip  it  off. 

We  '11  pinch  the  smaller  end  and  have  a 
tube,  the  larger  end  open.  We  '11  fill  it  with 
the  smallest  of  bird=shot  and  pinch  the  other 
end.  This  gives  us  a  weighted  =  rubber  bag 
filled  with  shot;  which  comes  within  about  five 
per  cent  of  solid  lead  in  weight. 

In  packing  we'  11  first  use  the  best  of  vulcan- 
ite around  the  pins  of  the  teeth,  or  in  the  holes, 
if  pinless  teeth.  Then  we  '11  lay  a  sheet  of 
weighted=rubber  on  either  side;  and  then  place 
our  bag  of  shot  down  between  the  two  side 
blankets;  then  go  on  and  complete  the  pack- 
ing with  weighted=rubber,  and  vulcanize  and 
finish  in  the  usual  way. 

But  use  only  the  best  of  rubber  in  front, 
where  the  plate  needs  all  strength  possible.  No 
weighted  rubber  there ;  nor  any  more  pink  nib- 
ber  than  actually  visible  in  wearing.  Never 
face  with  pink  rubber  any  farther  down  from 
the  teeth  than  is  actually  seen;  that  is,  if  you 
wish  to  be  honest  with  -the  wearer. 


132  Greene  Brothers'  Clinical  Course 

To  Strengthen  Lower  Vulcanite  Plate. 

Lower  plates,  especially  when  vulcanized  in 
the  visual  hurried,  careless  way,  should  not  only 
contain  the  best  of  rubber,  but  should  be  addi- 
tionally strengthened  in  front  with  appropriate 
metal.  This  is  on  the  market  and  should  be 
used — unless  the  very  best  of  rubber  is  used 
and  vulcanized  at  the  lowest  temperature  and 
long  enough,  and  left  in  the  flask  long  enough 
to  give  it  the  cow=hom  texture  and  strength. 

Mixed  Lower  Plates. 

It  is  sometimes  an  advantage  to  make  a 
lower  plate  wholly  or  partly .  of  heavy  molded 
metal:  wholly  when  a  maximum  of  both  weight 
and  strength  are  needed,  with  a  minimum  of 
bulk;  and  partly  when  a  maximum  of  weight 
with  a  minimum  of  bulk;  and  partly,  again, 
when  a  maximum  of  weight  with  a  minimum 
of ^  bulk  at  one  place  and  a  minimum  of  bulk 
with  a  maximum^  of  weight  at  another  place. 

For  instance,  a  few  years  ago  I  had  a  case 
where  the  natural  teeth  were  all  missing  from 
and  including  the  central  incisor  back,  and  all 
the  ridge  gone,  on  one  side,  but  all  the  teeth 
remaining  and  healthy  on  the  other  side.  The 
teeth  were  missing  on  the  left  side. 

Here  I  needed  bulk  on  the  side  where  the 
teeth  were  to  be  put  in,  and  a  small  but  heavy 
flange  to  nm  aroimd  on  the  lingual  side  of  the 
natural  teeth  to  balance  the  artiflcial  teeth  on 
the  opposite  side. 

I  had  no  chance  to  crown  nor  to  clasp  with.- 
out  sacrificing  one  or  more  healthy  teeth,  which 
I  didn't  want  to  malpracticingiy  do. 

So  I  first  cast  a  heavy  metal  plate  to  go  all 
aroimd  on  the  alveolar  lack=of=ridge  on  one  side 
and  to  fit  against  the  lingual  side  of  the  nat- 
ural teeth  on  the  other  side  of  the  mouth. 


IN  Dental  Prosthesis.  133 

This  heavy  plate,  small  in  bulk,  fitted  up 
fairly  close  to,  but  not  quite  touching,  the  nat- 
ural teeth;  and  also  around  behind  the  wisdoni= 
tooth,  resting  there  on  top  of  the  gums.  I  used 
vulcanite  (for  bulk)  tmder  my  artificial  teeth  on 
the  heavy  cast  plate. 

The  cast=metal  flange  on  the  opposite  side 
balanced  the  artificial  teeth,  and  it  was  a  suc- 
cess; though  others,  and  I,  had  "signally"  failed 
by  other  methods  before. 

Yes,  weight,  under  some  circumstances,  is 
a  good  thing;  indeed,  sometimes  by  the  old 
method  of  guess=file= trimming,  essential  for  real 
success, 

jBut,  fortimately,  I  've  invented  a  "Joker" 
that  will,  by  our  methods,  nearly  always  super- 
sede weight. 

Swaging  Lower  Plates. 

I  have  no  improvements  to  offer  to  the  best 
modem  methods  of  swaging  lower  plates;  ex- 
cepting that  in  the  use  of  modeling= compound 
impressions  I  'd  use  the  Greene  approximate 
non= changeable  model,  faced  with  an  equal  mix- 
ture of  the  best  Portland  cement  and  plaster, 
well  grotmd  together  in  a  mortar  before  the 
mixing. 

^^  Pouring  very  low=fusible  melted  metal  into 
a'^modeling= compound  impression  is  possible  if 
the  impression  is  very  cold  and  the  metal  at  its 
lowest  fusible  temperature,  but  it  requires  care 
that  some  dentists  won't  be  guilty  of.  The 
agents  who  sell  modem  swaging  machinery  are 
the  experts  to  teach  the  art;  and  it  is  to  their 
especial  interest  that  their  patrons  make  a  suc- 
cess of  the  work. 


134  Grekne;  Brothers'  Clinical  Course 

Cast  Aluminum  Plates. 

Cast  aluminum  plates  are  becoming  quite  a 
fad.  Like  in  all  other  prosthetic  matters,  it 
takes  practice  to  make  perfect  in  this.  I  have 
.seen  enough  of  it  to  know  it  can  be  done  per- 
fectly; and  yet  comparatively  few,  as  yet,  have 
the  art  perfectly  at  hand. 

Even  experts  seem  to  disagree  as  to  whether 
or  not  a  cast  aluminum  plate  is  as  impervious 
to  the  secretions  of  the  mouth  as  a  rolled  and 
swaged  one  is.  Again,  others  of  equal  experi- 
ence claim  the  metal  itself  is  not  fit  for  uni- 
versal use.  And  that  's  my  conclusion  from 
what  I  've  observed  of  it.  Anyhow,  it  's  gen- 
erally too  light  for  lower  plates. 

If  cast  plates  ever  become  common,  then 
the  Greene  method  of  taking  finished  test  im- 
pressions will  be  prized  the  more,  because  it 
eliminates  all  filing  of  plates  after  they  are 
made,  unless  the  mouth  changes. 

It  will  then  be  the  more  appreciated,  also, 
because  plates  will  be  cast  to  accommodate  the 
features,  as  well  as  to  fit  the  mouth. 

With  our  plumper=test,  the  aluminum  mold- 
er  will  not  have  to  wax  up  a  guess=plumper  and 
then,  maybe,  file  most  or  all  of  it  off  of  his 
plate  in  red=hot  stove=pipe  verbosity. 

Refitting  Lower  Cast  Metal  Plates 
WITH  Vulcanite. 

Lower  cast  metal  plates  can  be  either  re- 
fitted, or  wholly  renewed,  with  vulcanite.  When 
refitted,  the  procedure  is  the  same  as  we  have 
just  gone  through  in  refitting  rubber  plates,  only 
the  old  metal  plate  must  be  scarified  and  pre- 
pared to  hold  the  vulcanite  lining  mechanically. 
Of  course  you  are  all  familiar  with  that  matter. 


IN  Dental  Prosthesis.  135 

Substitution  of  Watt's  Metal  Plates 
IN  Place  of  Vulcanite  Ones. 

To  replace  a  Watt's  metal  lower  plate  in- 
stead of  a  vulcanite  one,  we  take  a  niodeling= 
compound  impression  in  the  old  vulcanite  plate, 
according  to  instrtiction  for  refitting;  and  test 
it  to  know  for  certain  the  plate,  when  done, 
will  both  fit  and  occlude  properly. 

But,  if  you  prefer  a  plaster  impression,  take 
it  by  the  "pass=word  method,"  so  you  can  act- 
ually test  it.     (Index  P.) 

When  your  impression  stands  the  test  and 
the  teeth  occlude  as  the}''  should,  then  invest 
«3^our  case  just  as  we  did  in  the  vulcanite  refit 
case;  only  use  a  Watt's  metal  flask  and  some 
suitable  investment  m^aterial,  instead  of  plaster. 
An  equal  mixture  of  plaster  and  powdered  pum- 
ice=stone  is  good  enough,  especially  if  ground 
together  dry  in  a  mortar  before  mixing. 

Open  the  flask  so  as  not  to  break  the  model, 
which,  of  course,  is  of  the  investment  material 
and  not  very  strong.  When  open,  heat  the 
plate=holding  half  of  the  flask  hot  and  remove 
the  whole  thing — teeth,  plate,  and  all.  Then 
remove  the  teeth  from  the  rubber  plate  and 
cement  them  back  into  their  places  in  the  in- 
vestment. 

Close  3^our  flask,  blow  in,  and  test  for  clear 
vents,  dry  thoroughly,  cover  flask=joint  with 
silex  and  investment  stuff,  heat  flask  hot,  tap 
and  pour  metal  in  slowh^ 

This  is  a  veiy  simple  thing  to  do,  after  you 
know  how  to  take  a  test  impression  in  an  old 
denture.  And,  when  it  's  done,  you  've  sub- 
stituted a  new  cast=metal  plate  instead  of  the 
old  vulcanite  one,  in  less  than  two  hours  from 
start  to  completion. 

Of  course  \o\x  understand  this  includes  both 


136  Greene  Brothers'  Clinical  Course 

a  re=adjustnient  of  the  teeth  and  correction|of 
articulation,  if  needed. 

To  Refit  and  Renew  a  Cast  Plate 
WITH  THE  Same  Material. 

This  process  is  just  the  same  as  any  other 
refit  up  to  the  time  of  flasking.  You  now  under- 
stand that. 

Now  use  any  flask  made  for  casting  lower 
plates  of  heavy  metal,  and  flask  as  usual  in 
that  sort  of  work;  using,  of  course,  some  proper 
investment  material  in  flasking,  instead  of  plas- 
ter— something  that  won't  crack  and  change 
by  heat.  The  pumice  =  stone  =  plaster  mixture 
will  do. 

Open  and  remove  everything  clean  that  con- 
stitutes your  impression;  close  the  flask,  after 
coating  the  investment  (not  the  teeth)  with 
liquid  silex;  then  blow  in  to  clear  your  vents. 
Then  silex  the  crack  between  the  two  halves 
of  the  flask  to  prevent  the  escape  of  the  melted 
plate = material. 

Then  dry  well  and  heat  it  hot  enough  to 
melt  the  old  plate  inside;  and,  while  thus  hot, 
pour  in  the  molten  metal  needed  to  make  up 
for  the  space  occupied  by  the  impression. 

Cool  it  and  take  it  out,  and  3^ou  '11  have 
both  a  refit  and  a  new  plate,  out  and  out. 


IN  Dental  Pros'i'hesis.  137 


LECTURE  NUMBER  THREE. 


ARTICULATION,  OCCLUSION,  BITE, 


And  All  They  Include,  from  a  Practical 
Standpoint. 

Well,  doctors,  in  our  "Third  Degree"  les- 
son we  're  "up  against"  some  of  the  most  tick- 
lish matters  that  come  within  the  w^hole  range 
of  our  practice. 

First:  the  bite;  and  then  all  that  follows 
till  we  finally  dismiss  our  patient.  In  the  word 
finally,  I  hope  you  fully  catch  my  meaning. 
It  sometimes  means  away  off,  and  always  an 
hour  of  rejoicing. 

In  dealing  with  the  subject  of  "articula- 
tion," as  the  word  is  broadly  used,  I  shall  try 
not  to  go  into  any  mystical  wording  nor  theoret- 
ical discussion.  I  '11  take  for  granted  you  've 
already  had,  probably,  a  surfeit  of  all  that — 
and  often  to  the  exclusion  of  really  practical 
information  on  the  theme. 

You  've  had  actual  measureinents  of  dead 
men's  jaws,  and  approximate  and  "average" 
theoretical  measurements  of  living  men's  jaws. 

You  've  had  maxilla r}'  gymnastics  and  con- 
tortive  movements  on  remote,  if  not  iinaginary, 
"planes"  and  hypothetical  curves  offered,  and 
sometimes  given  you,  till  you  maybe  feel  some- 
what as  the  old  farmer,  Moses  Gouge,  recently 
did  at  a  toney  town  "kay=fa3\"  (This  storv  is 
vouched  for  by  a  reliable  dentist,  who  insists 
on  my  using  it  as  a  happy  illustration  in  this 
lecture.) 

Waiter  (politely) :  ' '  Beef  steak,  pork  steak, 
chicken   giblets,    Belgian    hare,    qua il = on = toast. 


138  Grekne  Brothers'  Cunical  Course 

baked  fish,  fried  chicken,  codfish=balls,  turkey= 
breast,  rQutton=leg,  ham,  mackerel,  or  country^ 
made  sausage  ? ' ' 

Plain  Old  Commoner  (impatiently):  "0/z, 
you  make  me  tired!  Jist  go  'n'  git  me  the  com- 
mon, home=made  sassage  that  I  can  kind  o' 
chaw  with  this  gol=blasted,  jimble=tumble  set 
o'  teeth!  They  don't  strike  togetheh,  so  I 
can't  eat  nothin'  much,  neithah  hahd  nah  saft." 

A  new,  enthusiastic  disciple  of  "anatom- 
ical occlusion,"  across  the  table,  butted  in  and 
gave  the  old  Hay=seed  a  regulation  dissertation 
on  articulation  of  artificial  teeth,  in  "meter" 
terms,  on  "occlusal  planes,"  "condyle  paths," 
and  "face=bow"  measurements,  till  he  got  tired 
again: 

"Young  man,  young  man,  if  my  teeth  lacked 
o'  cummin'  togetheh  right  when  I  chawed  by 
your  way  o'  fixin'  'em,  accordin'  as  they  do  by 
the  tutheh  tooth  dentist's  lamt  gibberish,  I 
guess  I  couldn't  hold  'em  in,  even  when  I 
steadied  'em  with  a  big  chaw  o'  saft  terbacker 
on  both  sides.  If  I  could  only  jist  git  a  set 
that  'd  come  togetheh  right  even  one  way,  I  'd 
be  glad  to  hold  'em  that  way,  and  let  the  tuth- 
eh fellehs  have  thaim  to  move  in  them  uncom- 
mon ways,  which  you  tell  me  mine  had  ort  teh 
move  an'  come  togetheh  in. 

"In  fact,  strangeh,  to  be  honest:  while  I 
wouldn't  dispute  yoh  high  college  lahnin',  / 
can't  jist  see  how  yo'  're  gwoine  teh  make  a 
set  o'  teeth  that  'd  awlis  come  togetheh  right 
and  even  all  'round,  when  a  felleh  bit  in  dif- 
ferent ways.  I  know  that  even  my  old  ter- 
backeh=wohn=off  ones  didn't  do  that. 

"You  might  do  it  in  yoh'  'unknown  tongue,' 
but,  as  the  felleh  says,  'I  'm  from  Missouray.* 

"I  reckon,  of  kose,  if  the  old  Masteh  had 
tuken  sich  a  notion   in   His  head.  He  could  o' 


IN  Dental  Prosthesis.  139 

made  all  teeth  hit  togetheh  all  'round,  no  mat- 
teh  what  direction  we  bit  on  'em.  But  one 
thing  is  shoh:  He  didn't  [make  mine,  noh  none 
of  mv  five  wives',  noh  seventeen  chillem's  do  it. 

"Well,  I  may  say,  'ceptin'  in  one  case;  that 
o'  my  fo'th  wife,  Suz=an  Moriah.  An'  she  it 
was  who  made  hem  that=a=wa3^  heh  own  self. 
She  was  allez  stickin'  her  chin  out  an'  grittin' 
her  bulldog  teeth  at  me  an'  my  chillem  by  my 
tutheh  women.  She  woh'  her  front  teeth  off 
so  low  an'  even  that  she  could  bite  on  'em  any 
ways,  you  see. 

"But,  now,  I  wouldn't  want  my  neighbohs 
to  think  /  had  my  shop=made  teeth  patterned 
afteh  Moriah's,  nohow." 

Well,  doctors,  we  '11  first  set  up  a  double 
set  of  teeth  that  will  come  together  exactly 
right  "one  wa}^"  the  most  natural  way.  Then 
we  '11  set  them  to  strike  like  Suz=an  Moriah's, 
* '  any  ways  " ;   at  least,  any  practical  way. 

And  we  '11  do  it  without  any  circumlocution- 
ary^  verbal  mystification,  or  "unknown  tongue," 
to  describe  it;  or  even  complicated,  ponderous 
articulating  machinery,  that  requires  an  anat- 
omical engineer  to  run  it.  We  '11  try  to  make 
it  all  so  simple  that  even  a  wayfaring  (etc.) 
dentist  can  imderstand. 

My  purpose  is  to  show  you  how  to  take  a 
test  articulation  (so-called  "bite")  and  prove 
its  correctness  in  advance,  the  same  as  we  test- 
ed our  impressions;  and  how  to  set  up  teeth 
in  even  the  common,  old  plain  line  articulator, 
and  get  all  the  movements  the  jaw  makes  in 
practical  use — and  even  more,  too,  if  you  want 
them.  Yes,  and  as  for  that,  accomplish  the 
same  results,  even  without  any  articulator  at 
all,  other  than  the  mouth  itself. 

One  of  the  best  plate=workers  I  have  ever 
laiown,  working  b}''  the  old  guess=work  methods, 


140  Greene  Brothers'  Clinical  Course 

has  made  artificial  dentures  for  fifty=eight  years, 
and  has  never  had  an  articulator  in  his  office. 

And  though  I  have  used  articulators  my- 
self for  forty-six  years,  I  will  here  say  that  if 
I  had  no  advance  test  methods  in  getting  the 
true  relations  of  the  jaws  (the  "bite"),  but  had 
to  guess=off  everything,  as  I  used  to  do,  and 
as  most  other  dentists  still  do,  I  would  now 
throw  my  artificial  articulators,  "anatomicals  " 
and  all,  onto  the  junk=pile.  For,  without  this 
true  relation,  the  best  of  them  are  not  only 
faulty,  but  may  be  absolutely  misleading. 

But,  with  the  certainty  of  the  true  relation 
of  the  jaws  at  rest,  and  a  close  approximation 
to  their  movement  in  action  (the  "average"), 
and  with  an  articulator  to  help  manifest  these 
relations,  we  get  a  very  close  approximation  to 
a  correct  articulation  and  occlusion. 

There  is  no  trouble  in  getting  the  exact,  true 
relation  of  the  jaws  at  rest  in  any  individual 
case.  But  as  to  their  relation  when  in  motion 
we  must  be  content,  at  the  first,  to  get  even  a 
close  approximation. 

We  have  been  given  the  true  measurements 
of  dead  men's  jaws  and  ingenious  face  =  bow 
measurements  of  living  men's  jaws,  "occlusion 
planes,"  and  "condyle  paths,"  and  the  like,  even 
imto  hypertechnics.  And  thanks,  honor,  and 
glory  to  the  men  who  have  given  them.  Their 
teaching  is  often  helpful. 

But,  unfortunately,  when  most  needed,  the 
starting  points  can't  be  located  with  certainty 
(excepting  by  the  imagination  of  enthusiasts) 
and  the  measurement  is  onl}^  approximate,  af- 
ter all.  Not  all  jaws  move  alike,  nor  does  the 
same  jaw  move  always  on  both  sides  alike,  nor 
does  the  same  jaw  at  all  times  move  the  same. 

So  we  sometimes  have  to  vv^ork  to  greatly 
varying    bone    anatomy;,    of    impossible    actual 


IN  Dental  Pkosthesis.  141 

measurement,  and  to  irregular  muscular  move- 
ments, that  just  can't  be  relied  on  at  all,  ex- 
cepting as  a  plausible  theory. 

But  nevertheless  we  can  deal  with  each  in- 
dividual case  on  its  own  merits;  and  get  prac- 
tical results,  no  matter  about  the  size  or  shape 
or  angle  of  the  jaw=bone.  As  a  whole,  shortly 
told,  we  '11  do  as  we  did  in  our  impression. 
We  '11  get  first  an  a[)proximation  and  then  cor- 
rect up  to  exactness  in  these  matters  of  articu- 
lation and  occlusion. 

So  now,  as  to  the  not  only  varying,  but 
even  changing  muscle  movements  that  we  must 
deal  with. 

In  articulation  we  sometimes  can't  depend 
on  adjusting  our  work  to  the  movements  of  the 
muscles  that  operate  the  jaw.  We  rather  must 
depend  on  adjusting  the  movements  to  our  work. 

I  am  aware  how  absurd  it  may  seem  to 
some,  at  first,  to  propose  to  adjust  the  jaw 
movement  to  a  set  of  teeth;  and  yet,  if  it  were 
not  possible  and  expedient,  the  most  grateful 
science  of  orthodontia  would  be  fatalh^  crippled. 

The  orthodontist  must  sometimes  adjust  the 
maxillary  connections  and  accommodate  their 
action  to  the  position  he  has  given  the  natural 
teeth.  He  couldn't  have  gotten  his  grateful 
results  without  having  trained  the  movements 
of  the  muscles  (that  moved  the  jaw)  to  his 
work;  that  is,  to  his  changed  position  of  the 
natural  teeth. 

Now  FOR  THE  "Bite." 

The  too  common  idea  of  a  bite  is:  the  nat- 
ural, horizontal  relation  of  the  alveolar  ridges 
of  the  upper  and  lower  jaws.  It  is,  however, 
correct  as  far  as  it  goes;  but  it  doesn't  go 
far  enough.  To  this  limited  idea  should  be 
added:  when  they  are  at  proper  distance  apart, 
perpend  icularly. 


142  Grekne  Brothers'  Clinical  Course 

Even  the  horizontal  relation  of  the  jaws 
often  changes  as  the  distance  apart  varies. 

Then,  a  practical  definition  of  a  so=called 
"bite"  would  be:  The  natural,  horizontal  re- 
lation of  the  jaws  when  at  their  proper  distance 
apart.  The  distance  apart  meaning  the  length 
of  the  teeth  to  be,  plus  the  combined  thickness 
of  the  bite=plates  used. 

But  strange  how  many  dentists,  including 
some  of  the  brightest  among  them,  fail  to  con- 
sider the  distance  apart  of  the  jaws  in  taking 
a  bite.  Indeed,  I  've  found  more  than  a  few 
who  contended  even  that  the  distance,  or  width 
of  the  bite,  makes  no  difference;  hence  they 
could  change  it  at  will  after  taken. 

For  example:  If  you  need  a  starter  for 
thinking  on  this  feature  of  our  theme,  just  open 
your  own  mouths  and  observe  how  much  faster 
the  space  increases  between  your  front  teeth 
than  between  your  back  ones. 

What  's  true  of  your  natural  teeth  would 
hold  just  the  same  with  your  gums,  without 
your  teeth;    or  with  plates  of  artificial  teeth. 

No  correct  bite  (or  horizontal  relation  of  the 
jaws)  at  any  given  distance  apart  would  be  cor- 
rect at  any  other  distance  apart. 

Then  the  first  thing,  and  the  thing,  in  tak- 
ing a  bite  is  to  settle  on  the  distance  apart 
you  want  the  jaws;  or,  in  other  words,  the 
combined  length  of  your  'teeth,  including  thick- 
ness of  their  plates.  And  now  this  must  be 
exact,  too. 

Nor  can  it  be  changed  after  settled=on  and 
in  the  articulator,  unless  your  articulator  pro- 
vides for  the  opening,  or  closing,  at  the  heel  the 
same  as  in  front. 

Nor  is  any  change  of  this  sort  (widening  or 
narrowing  of  bite)  ever  necessary,  if  you  will 
ascertain  to  a  certainty,  before  you  take  your 


IN  Dkntal  Prosthesis.  143 

bite^how  long  you  want  your  artificial  teeth, 
includingjplate,  to  be.  That  is,  in  effect,  how 
much  you  want  your  teeth  to  show.  We  'U 
call  it  their  show=length.  And  this  is  easily  de- 
termined and  settled  with  certainty,  as  you  will 
presently  be  shown. 

Absurdity  of  a  Common, 
MoTiONARY  Bite. 

In  all  dental  prosthesis,  and  indeed  in  all 
dentistry,  and  in  all  the  unphilosophical  ideas 
and  acceptations  therein,  there  is  no  greater 
uncertaint}^  than  that  of  a  common,  motionary 
(pardon  the  doubtful  but  needed  new  word) 
bite;  no  matter  in  what  "way"  nor  how  you 
may  take  it. 

In  fact,  when  closely  scrutinized,  it  amounts 
to  practically  an  absurdity,  even  though  you 
do  sometimes  get  the  correct  relation  of  the 
jaws  by  it.  In  certain  kinds  of  difficult  cases, 
to  be  mentioned  later  on,  success  would  have 
to  be  almost  an  accident. 

Absurd  for  this  reason:  You  ask  your  pa- 
tient to  give  you  her  "natural"  bite,  when  she 
reall)^  has  no  regular  bite  to  give. 

She  used  to  have  a  regular,  or  habitual, 
bite  when  she  had  her  natural  teeth.  The  teeth 
then  held  her  jaw  in  a  certain  position  so  much 
of  the  time  that  it,  in  fact,  regulated  and  es- 
tablished the  movement.  And  that  movement 
then  was  her  "natural"  bite. 

She  then  had  no  trouble  at  all  in  opening 
and  closing  her  mouth  very  nearly  the  same 
way  every  time;  the  same  as  when  habit  reg- 
ulates the  muscles  that  give  the  drilled  soldier 
the  same  ' ' regulation  step''  every  time,  if  there  's 
nothing  to  interfere. 

You  and  I  who  have  teeth,  either  natural 
or  long=wom  artificial,  have  our  habitual  ("nat- 


144  Grukne  Brothers'  Ci,inicai.  Course; 

tiral")  bites.  But  pull  our  teeth  out'^and  let 
our  jaws  hang  loose  awhile,  like  a  bell= clapper, 
or  clock=pendulurQ,  then  our  muscles  that  move 
our  jaws  relax  and  lose  their  habitual  action. 
Then  we  have  no  natural  bite  to  give.^'  We 
have  simply  lost  our  habitual  bite.  ^    ^ 

And  then  to  cram  a  mouth  full  of  unnatural 
filling  and  under  such  circumstances  to  expect 
a  natural,  same  bite  is  the  acme  of  presump- 
tion, if  not  an  absurdit}^  I 

So,  we  'd  just  better  take  for  granted  that 
our  patient,  having  no  longer  a  certain  habitual 
action  of  her  jaw,  can't  control  her  movement; 
the  movement,  mind  you.  That  is,  she  can't 
bite  for  us  reliably. 

Tired  Relaxation  the  Natural 
Position  of  the  Jaw. 

But,  though  she  has  no  longer  an  estab- 
lished, habitual  movement  of  her  jaw,  she  al- 
ways has  a  natural  rest  position  of  it.  We  '11 
call  it  a  tired=rest  position. 

For  instance  (to  my  clinic=student  at  my 
left) :  Madam,  let  us  illustrate  our  case.  Open 
your  mouth  and  stick  your  jaw  out  at  me  for 
a  little  while.  Don't  let  your  teeth  come  quite 
together;  but  hold  them  just  that  way  a  few 
moments. 

Now,  how  long  could  you  hold  it  in  that 
strained  position,  with  nothing  to  rest  on  ?  "  Not 
long,"  you  say.  No,  of  course  not;  but  what 
would  happen  when  you  couldn't  hold  it  out 
any  longer? 

"It  would  go  back,"  you  reply.  Back,  but 
where  to? 

"Back  to  its  natural  place,  of  course,"  you 
answer. 

That  's  it!  When  your  jaw  is  tired,  it  goes 
back  to  its  naturaUrest  position.     But  it  doesn't 


IN  Dental  Prosthesis.  145 

have  to  be  stuck  out  that  way  to  tire  it,  at  all. 
We  can  tire  it  in  a  simpler  wa}^  than  that.  I 
have  \xsedJthat\wsiY  to  impress  you  with  the 
principle. 

We  can  tire  your  jaw  quite  sufficiently  in 
ajminute  or  less  by  merely  holding  your  gums 
apart,  with  your  lips  lightly  touching.  We  '11 
apply  the  principle,  in  taking  a  bite,  now  soon. 

What  Do  We  Expect  from  a  Bite? 

There  are  four  important  points  that  we 
should  secure  in  a  bite. 

First:  The  length,  or  showing  (show=length) 
of  the  teeth. 

Second:  The  out=  standing,  or  in=  standing,  of 
them. 

Third:  The  come= together,  or  occlusion,  of 
them. 

Fourth,  but  not  least:  The  strain,  or  press- 
ure, with  which  they  come  in  contact. 

Though  the  fourth  point  is  imthought  of  by 
ninety-five  per  cent  of  dentists,  it  is  extremely 
important;  since  the  whole  matter  of  occlusion 
may  largely  depend  on  it.  We  will  deal  at- 
tentively with  point  four  in  its  place  a  little 
later  on. 

There  are  two  methods  of  taking  a  bite, 
with  variations  in  both.  One  is  known  gener- 
ally as 

The  "Biscuit,"  or  "Mush,"  or 
"Squash,"  Bite. 

It  consists  in  placing  a  roll,  or  chunk,  of  wax, 
or  other  material,  in  the  mouth  and  having  pa- 
tient simply  "bite"  on  it.  The  other  is  known 
as 

The  Rim  Bite. 

Base=plates  are  made  of  various  materials 
to  approximately  fit  the  gums,  and  rims  of  wax, 


146  Greene  Brothers'  Ceinical  Course 

or  other  material,  placed  on  them;  then  bit=on 
and  marked,  and  fastened  together  on  their 
models,  in  the  articulator.  These  are  the  two 
methods,  given  without  detail;  and  it  is  sup- 
posed that  you  are  familiar  with  one  or  the 
other,  or  both  of  them.  My  only  use  for  them 
is  as  a  basis  for  illustration  and  improvement. 

By  the  biscuit  bite,  3^ou  get  no  one  of  the 
four  points  needed,  exactly;  and  seldom  very 
approximately,  unless  sometimes  when  it  is  pro- 
vided to  give  the  first  one  (length  of  teeth),  in 
a  way,  by  use  of  a  "bite=stick." 

This  is  accomplished  by  placing  a  piece  of 
wood  in  the  "biscuit"  to  stop  the  lower  jaw 
at  the  proper  distance  from  the  upper  one,  and 
so  give  the  length  of  the  teeth. 

But,  as  this  is  seldom  done,  it  is  safe  to  say 
that  generally,  in  the  biscuit  bite  you  get  noth- 
ing you  want,  excepting  a  very  remote  approx- 
imation of  the  relation  of  the  jaws.  It  is  really 
about  all  guess=work. 

And  whatever  success  is  attained  to,  can  be 
attributed  to  your  experience  and  good  guess- 
ing, in  setting  up  the  teeth  and  trying  them  in 
the  mouth;  the  unreliability  of  which  will  be 
dealt  with  later  on. 

By  the  way,  before  we  close  this  demonstra- 
tion, we  '11  give  you  some  important  improve- 
ments on  the  old  "mush"  bite,  that  you  can 
give  your  friends  who  persist  in  its  use.  For 
yourselves,  you  '11  have  no  further  use  for  the 
method,  even  improved. 

This  rim  =  bite  method  was  originally  in- 
tended to  give  the  first  three  of  the  aforemen- 
tioned points;  that  is,  length,  prominence,  and 
occlusion. 

But,  as  the  method  has  been  seldom  prop- 
erly taught  and  practiced;  and  as  faulty  ma- 
terials have  been  used;    and  as  dentists,  dis- 


IN  De;ntaIv  Prosthesis.  147 

couraged,  have  adopted  and  rely  on  the  "try= 
m=the=mouth "  plan;  and  as  the  rim  bite  (as 
it  is  commonly  used)  has  ta  be  followed  up  by 
cut=and=tr3^  guess=work  to  get  even  what  is  at- 
tainable by  it,  I  '11  give  you 

The  Greene  Improved  and  Perfected 
Rim  Bite. 

This  gives  all  the  four  requisite  points  with- 
out any  guess=work.  And  this  is  the  work  we 
are  now  up  to. 

Bite  for  a  Full  Upper=and=Lower  Set. 

We  have  our  models,  over  which  we  are  go- 
ing to  vulcanize,  or  swage,  our  plates.  If  we  take 
good  impressions  of  them,  in  "Perfection"  Im- 
pression Compoimd  material,  our  impression= 
bite=plates  will  fit  to  the  gums  about  as  w^ell 
as  the  finished  plates  made  from  them  will  fit 
later  on.  And  a  good=fitting  bite=plate  is  an 
essential  in  the  bite.     Don't  lose  thought  of  this. 

Upper  Model  First. 

We  '11  take  our  upper  model  first;  lay  it 
down  on  the  table,  face  upward,  soapstone  it 
well,  and  carefully  take  a  "Perfection"  mate- 
rial impression  from  it. 

This  impression,  taken  without  a  tray,  will 
have  a  rim  of  ample  thickness  and  prominence, 
for  trimming  down  to  what  we  may  want.  But 
its  palatal  arch  will  be  pressed  down  thin — say, 
down  to  an  eighth  of  an  inch  in  thickness — to 
avoid  bulk;  and  made  smooth.  It  will  then 
constitute  our  bite=plate,  in  the  rough. 

In  a  few  cases,  where  a  model  will  have  a 
projection,  you  will,  before  taking  an  impres- 
sion of  it,  have  to  core  out  the  "under=cut" 
with  a  little  compound,  and  cover  this  with  thin 
foil,  so  as  to  get  it  off  the  impression  without 
damage  or  trouble. 


148  Greene  Brothers'  Clinical  Course 

I  :  Trim  for  Fullness  of  L'Pper 

Lip  and  Teeth. 

We  '11  now  put  it  into  our  patient's  mouth, 
after  a  little  explanation  to  her,  and  say:  ' '  Now, 
Madam,  suck  that  up  tightl}^"  ||| 

To  begin  with,  it  purposely  makes  her  lip 
a  little  too  prominent.  But  we  trim  off  until 
it  suits  us  as  to  fullness  of  expression — without 
regard  to  the  lower  jaw,  at  all.  In  fact,  we 
hold  our  hand  over  the  lower  lip,  during  the 
adjustment  of  the  upper  one,  to  avoid  being 
misguided  by  the  contrast. 

The  trimming  is  done  similarly  to  that  in 
side=trimming  an  im.pression:  first  warming  the 
outer  surface  to  a  very  slight  depth  over  a 
hand=lamp,  and  then  using  a  sharp  pocket=knife. 
It  now  represents  the  fullness  of  our  comiing 
denture  all  around. 

While  I  'm  not  here  to  teach  you  physiog- 
nomatic  taste,  at  all,  I  will  suggest  that  you 
don't  give  3'our  patients  a  cat=fishy  appearance 
by  too  square  a  front  and  too  prominent  bicus- 
pids— a  very  common,  distortive  habit  among 
dentists.  And  always  beware  of  tucking  the 
front  teeth  inward,  or  the  bicuspids  outward,. 
too  m.uch;  especially  for  a  woman — unless  you 
want  to  make  her  husband,  or  beaux,  look  at 
some  other  face.  All  dentists  guilty  of  this 
unpardonable  sin  against  featural  symmetry 
should  be  dedicensed.  And  oh,  what  a  lot  of 
vacant  chairs  there  would  be! 

Trim  Bite=Plate  for  Length 
OF  Upper  Teeth. 

Next  we  '11  get  the  ' '  lipdine ' '  for  the  show* 
length  of  our  artificial  teeth.  This  you  can  get 
in  your  usual  wa}^  whatever  that  is;  only  be 
sure  •  you  get  it.  I  prefer  to  use  the  laugh* 
stunt,  as  a  iTile. 


IN  Dental  Prosthesis.  149 

We  look  her  in  the  eyes  blandly  and  say: 
"Madam,  please  smile  or  laugh  a  little  at  me, 
will  you?"  She  laughs,  always  promptly,  when 
told  to.  So  we  trim  till  we  get  the  rim  to  rep- 
resent the  exact  length  we  want  the  teeth  to 
show;  that  is,  their  show=length  as  far  back  as 
they  will  show: 

Then,  not  as  a  matter  of  taste,  but  as  one 
of  mechanical  philosophy,  trim  off  the  rest  of 
the  rim  behind  so  as  to  curve  gradually  upward; 
and  make  your  last  molar  as  short  as  possible 
(the  exception  would  be  where  you  want  to 
prevent  the  cheek  from  falling  inward);  first, 
that  your  denture  ma}^  have  the  "compensat- 
ing curve"  (incidentally);  but  for  another  more 
potent  reason  than  the  one  usually  given,  to  be 
explained  later  on. 

So  now  we  have  our  upper  rim=bite=plate  to 
represent  our  teeth  when  set  up.  It  will  be 
our  guide,  too,  in  setting  them  up. 

Next  we  '11  do  the  same  thing  in  our  lower 
case.  As  in  the  upper,  we  '11  get,  again,  our 
rim=plate  im^pression  from  our  lower  model  (or 
from  the  mouth,  as  for  that).  But  we  must 
see  that  it  will  stay  down — somewhat,  at  least — 
to  its  place  in  the  mouth.  This  is  important 
and  almost  essential  in  getting  an  ante=test 
bite.  If  the  mouth  has  an  alveolar  ridge,  it 
will  suck  down;  but,  if  not,  we  must  other- 
wise provide  for  its  down = stay. 

In  this  flat,  flabby  case,  we  must  have  a 
substitute  for  suction  in  our  lower  bite = plate. 

Heavy  Lower  Bite=Plates. 

Here  watch  my  most  valuable  little  invention 
ever  made  in  bite=taking.  We  '11  take  the  im- 
pression of  our  lower  model  with  heavily  weight- 
ed molding  compound — that  is,  compound  with 
fine  bird=shot  well  kneaded  into  and  throua^h 


150  Gre;e;ne:  Brothers'  Clinicai.  Coursk 

it;  and  even  with  small  bars  and  rolls  of  lead 
also  worked  into  the  rim,  i£  necessary,  to  hold 
it  down  to  place/ 

Trim  Lower  Bite=Rim  for  Length 
OF  Lower  Teeth. 

We  're  now  ready  for  trimming  and  fitting 
our  lower  bite=plate  to  the  upper  one.  But 
we  '11  reverse  the  order  and  get  the  show=length 
for  the  teeth  first.  Don't  forget  that  in  the  up- 
per case  we  first  got  the  fullness  and  then  the 
show=length;  but  in  the  lower  case  it  is  ex- 
actly reversed. 

And  now,  doctors,  here  is  the  way  we  get 
the  lower  bite=rim  to  the  show=length  of  the 
lower  teeth;  and  also  get  it  to  fit  to  the  upper 
rim.  For  they  must  fit  to  each  other  perfectly; 
their  edges  occlusively  and  outer  sides  evenly, 
laterally. 

With  the  upper  bite=plate  left  out,  we  place 
the  lower  one  in  the  mouth  and  mark  the  lip= 
line,  and  trim  to  it  in  front — say,  to  about  the 
combired  width=space  of  the  incisors.  In  scim- 
tinizing  for  the  length  of  the  teeth,  look  at  this 
trimmed  place  only,  for  it  is  the  stop=guide  to 
the  rest  of  the  trimmxing,  to  be  made  elsewhere. 

When  this  guide=point  is  down  to  the  show* 
length  we  want  the  teeth  to  be,  we  soapstone 
or  tin=foil  this  trimimed  spot.  Then  insert  the 
upper  plate,  with  its  full  occluding  edge  like- 
wise soaped,  or  foiled,  and  cool.  Then  warm 
the  occluding  edge,  only,  of  the  lower  plate,  and 
have  patient  to  bite  down  quickly.  (This  isn't 
taking  the  bite.) 

The  trimmed  guide=point  is  cool  and  hard 
and  immuned  from  sticking,  while  the  rest  of 
the  rim  is  soft  on  top,  so  it  will  mash  down  in 
forced  contact  with  the  hard  upper  rim.  In 
an  instant  she  has  mash  =  trimmed  her  lower 
bite=plate  to  exactly  fit  her  upper  one. 


IN  Dental  Prosthesis.  151 

Now  when  we  trim  off  the  mashed =down 
surplus,  our  whole  lower  bite=plate  rim  repre- 
sents the  coming  lower  denture  as  to  its  show= 
length,  or,  rather,  height;  but  only  as  to  that. 
It  "  compen sat ing= curves  "  upward  at  the  heels, 
too. 

The  Outstanding  of  the  Lower  Teeth 

is  our  next  point  to  make. 

We  must  now  trim  the  outer  side  of  this 
lower  rim  off  all  around  even  with  the  upper 
one.  And  the  two  rims  must  be  even  with  each 
other  when  they  are  in  their  exactly  true  natural 
relation  to  each  other.  That  is  to  say,  when  we 
have  the  correct  so= called  "bite." 

When  we  determined  the  show=length  of  our 
teeth,  at  the  laugh=line,  or  elsewhere,  we  set- 
tled, by  critical  observ^ation,  the  perpendicular 
relation  of  the  two  jaws;  now  we  must  settle 
their  horizontal  relationship.  This  can  be  done 
with  certainty,  only  when  the  lower  jaw  is  at 
tired  relaxation,  which  is  normal  rest. 

And,  doctors,  whether  deserving  or  not,  I 
will  here  venture  to  throw  a  little  bouquet  at 
my  ovv^n  old  feet.  Whether  the  discovery  is  orig- 
inal or  not,  I  am  sure  I  have  never  known  it 
mentioned,  in  all  the  forty  years  of  my  prac- 
tice and  association  with  dentists,  before  I  be- 
gan to  teach  it  in  my  private  Course  a  few 
years. 

I  mean  the  taking  of  an  immotionary,  still 
bite;  or  no=bite,  as  I  will  now  call  it  to  the  end 
of  these  demonstrative  talks. 

But  even  though  the  idea  were  not  original, 
to  be  the  unquestioned  introducer  of  it  practic- 
ally to  the  profession  is  sufficient  honor. 

The  Tired=Rest  Test=Bite,  or  "No=Bite." 

We  will  now  take  it,  then  trim  the  lower 
plate=rim  off  to  evenly  match  the  upper  one. 


152  Gre;sne  Broth£;rs'  Clinicai.  Course 

I  could  describe  the  process  more  briefly, 
but  less  impressively;  so  I  11  use  our  dummy 
patient  in  the  demonstration: 

"Madam,  you  now  have  the  two  plates  in 
your  mouth.  They  will  stay  to  their  places. 
Look  me  in  the  face,  listen  to  what  I  say,  get 
my  idea  clearly,  and  do  promptly  what  I  tell  you. 

"Close  your  mouth  till  your  lips  come  to- 
gether lightly;  but  let  the  plates  remain  just 
a  little  hit  apart,  but  so  they  'II  almost  touch." 

The  plates  are  within  about  an  eighth  of 
an  inch  of  each  other,  and  too  near  to  admit 
of  unintended  lateral  motion  in  closing  this  last 
minimum  space  under  the  directions. 

"There,  there,  you  have  it  right!  Watch, 
listen,  hold  just  that  way  till  I  slowly  count 
ten.  Then  bite  down  somewhat  firmly,  and 
hold  down,  no  matter  what  I  may  do  with 
your  lips.  Watch:  One,  two,  three,  four,  five, 
six,  seven,  eight,  nine,  ten — snap!     Hold  firmly. 

The  upper  rim  sits  down  on  the  lower  one 
at  tired  =  rest  position — -provided  neither  plate 
moved.  And  here  you  see  the  utmost  import- 
ance and  necessity  of  well  =  fitting  bite=plates. 
If  one  or  the  other,  or  both,  had  slipped,  ever 
so  little,  the  result  would  have  been  equivalent 
to  that  of  a  really  wrong  bite,  to  that  extent. 
And  how  man}^  bad  bites  of  i;;his  sort  have  we 
all  had  from  bad=fitting  and  sliding  bite=plates? 
How  many  hundred  have  you  had  ? 

Are  you  all  impressed?  .  If  so,  we  will  re- 
turn to  our  patient. 

"Hold  still.  Madam,  while  I  mark  the.  lower 
plate." 

I  here  take  a  small  instrument  with  a  right- 
angle  turn  near  its  point  and  scratch  all  around 
on  top  of  the  extending  lower  rim,  against  the 
trimmed  upper  one .  That  is  to  say,  my  upper 
nxa,  guides  ray  marker.     Then,  to  rest  my  pa- 


IN  Dental  Prostitesis.  153 

tient,  I  take  l^oth  plates  out  and  trim  the  lower 
one  off  to  the  scribe  carefully.  This  brings 
them  both  even;  and  even,  too,  when  the  jaws 
are  in  their  natural  relation — provided  I  can 
"show"  it  (and  I  proudly  hail  from  the  "Show= 
me"  State). 

Well,  I  have  now  attained  the  third  one  of 
my  four  essential  points  in  a  bite:  (i)  show= 
length  of  the  teeth;  (2)  the  come=together;  and 
(3)  the  lip  and  face  features.  The  teeth  will 
relate  just  as  these  bite-rims  do. 

Re=Inspect  No=Bite  for 
Feature  Test. 

But,  to  make  sure  the  face  features  will  suit 
me,  and  thus  help  me  to  "suggest"  my  patient, 
I  '11  replace  the  whole  thing  in  the  mouth  and 
re=inspect. 

After  all  this,  however,  you  '11  not  need  to 
make,  on  an  average,  one  change  in  twenty- 
five.  But  should  you  see  fit  to  do  so,  all  that 
you  need  to  do  is  to  re=trim  your  rims  in  the 


Fig.  16. 

Fig.  16. — Greene  Tired-Rest  Test-Bite  (no-bite),  with  molding- 
compound  impressions,  as  bite-plates — (in  this  case  handleless 
trayg).     The  models  are  made  when  case  is  articulated. 


154  Greenic  Brothers'  Clinical  Course 

same  way  you  did  in  the  first  place,  but]  more 
carefully.  ^-^ 

You  can  place  your  bite=plates  on  their  mod- 
els, warm  the  rims,  and  push  them  outward  or 
inward.  You  can  trace  compound  (at  least,  this 
"Perfection"  brand)  on,  or  add  it  in  strips,|for 
more  extension;  or  trim  it  off  for  reduction. 

Fourth  Point,  or  Pressure  Feature, 
IN  A  Bite. 

Next  and  last  comes  the  fourth  point  of 
essentiality  in  a  bite.  This  is  the  pressure,  or 
strain,  with  which  it  must  be  taken.  (And 
here  I  '11  take  the  risk  of  justification  in  another 
bouquet  at  my  own  feet.) 

In  traveling  fifty  thousand  miles,  in  ten 
years,  among  dentists,  I  have  found  less  than 
a  score  who  had  ever  thought  (out  loud,  at 
least)  of  the  importance  of  the  strain  with  which 
a  bite  is  taken;  or  even  of  a  set  of  teeth  set 
up  together.  And  only  one  of  these  had  at- 
tempted to  regulate  the  matter  in  his  work. 

I  fraternally  wish  I  could  recall  his  name; 
he  was  in  my  first  class  in  Washington,  D.  C, 
in  January,  1907.  He  had  invented  an  inge- 
nious little  instrument  to  measure  and  regulate 
dental=plate  pressure;  only  he  hadn't  had  time 
to  perfect  his  appliance  to  his  own  satisfaction. 
His  purpose,  of  course,  was  to  apply  it  in  a  bite. 

A  Simple,  Practical  Pressometer. 

We  have  been  over  and  over  the  importance 
of  taking  impressions  at  about  the  stress  a  plate 
is  to  be  worn — as  a  rule  w^th  few  exceptions. 

Well,  it  's  just  about  as  important  that  a 
bite  should  be  so  taken,  too.  Otherwise,  our 
occlusion  wouldn't  be  as  expected,  and  we  'd 
have  more  or  less  after =grinding  to  do,  or  else 
waiting  to  do  till  the  tissues  absorbed  and  ad- 


IN  Dental  Prosthesis.  155 

justed  themselves  to  the  plates.  Many  a  bad 
occlusion  is  the  direct  result  of  improper  press- 
ure in  bite = taking. 

It  is  astonishing  how  many  of  us,  includ- 
ing scores  of  our  deep  "anatomical"  thinkers, 
have  so  long  danced  blindly  all  around  this 
now  plainly  visible  goddess  in  the  popular  Oc- 
clusion Show. 

But  we  have  all  heard  of  the  poor,  tired 
prospector  who  sat  down  on  a  boulder  of  gold, 
at  Cripple  Creek,  Colo.,  to  unwittingly  rest  on 
a  fortune,  after  he  'd  worn  himself  out  at  dig- 
ging and  searching  for  it  with  a  microscope,  in 
doubt,  away  down  in  the  unknown  depths  of 
the  mountain. 

If  I  hadn't  such  well=grounded  prejudice 
against  commonly  slandered  names,  I  'd  call 
my  instrument  "Eureka."  But  I  '11  wait  till 
some  other  fellow  ' '  invents ' '  the  same  thing  and 
let  him  so  name  it.     I  '11  christen  it:  Pressometer. 

To  describe  it  and  show  its  workings,  we  '11 
go  back  to  our  finished  no=bite.  It  looks  like 
it  is  finished,  for  the  plates  seefn  to  come  to- 
gether all  around  alike.  In  fact,  in  a  way  they 
do  so.  But  we  don't  know  yet  how  much  more 
strain  —  excessive  strain  —  is  being  made  some 
place,  or  places,  than  at  others  to  make  them 
do  so. 

If  it  takes  too  m-uch  strain,  the  teeth  wouldn't 
come  together  perfectly  at  the  natural  strain  at 
which  they  will  be  worn.  And  of  course  other 
difficulties  come  ' '  in  flocks  and  droves ' '  in  con- 
sequence of  improper  occlusion. 

How  TO  Use  the  Greene  Pressometer 
IN  A  Strain  Test. 

■  *As  a  test  of  stress,  we  '11  use  these  two  ri ar- 
row, thin  strips  of  celluloid,  or  its  equivalent, 
about  half  an   inch  wide,   one= thirtieth  of  an 


156  Greune;  Brothe;rs'- Clinical  Course 

inch  thick,  and  four  inches  long.  They  are  as 
smooth  and  shck  as  a  glass  mirror.  They  are 
beveled  at  one  end,  so  I  can  lay  one  on  each 
side  of  my  lower  bit=rim  (in  the  mouth)  and 
have  them  come  jointly  together  in  front,  form- 
ing a  letter  V.  "^ 

They  are  also  rounded  off  on  the  outer  side 
at  the  heels,  so  as  not  to  be  caught  by  the 
cheek.  And,  when  laid  to  place  for  use  on  the 
lower  bite=rim,  they  also  project  out  in  front 
beyond  the  bite=rims,  so  I  can  handle  them 
with  thumb  and  finger.  The  two  together  con- 
stitute the  full  pressometer. 

In  a  simple  case  like  this,  I  place  the  two 
halves,  ore  on  each  side,  on  my  lower  bite= 
rim,  with  the  letter  V  pointing  toward  me. 

"Now,  Madam,  bite  down  on  these  strips." 

She  bites,  and  they  both  are  held  fast;  but 
this  proves  nothing;  for  I  don't  know  how  un- 
duly hard  she  is  biting  down,  nor  how  much 
some  parts  of  her  gums  are  giving  way  more 
than  other  parts,  to  make  thera  thus  tightlv 
hold. 

Then  I  say:  "Hold,  Madam,  hold!  Bite 
lightly:' 

She  bites  lightly,  when  one  of  my  test  pieces 
holds  tightly,  while  the  other  slips  loosely  be- 
tween the  plates.  This  shows  there  was  more 
strain  on  the  tight  side  than  on  the  other  one, 
for  the  slips  are  of  the  same  thickness. 

I  now  take  the  lower  plate  out  and  file  it 
off  (it  is  here  modeling  compound)  with  a  coarse 
vulcanite  file,  and  try  it  back.  Now  when  she 
bites  lightly,  they  both  hold  alike  and  slip  alike, 
loosely,  showing  the  pressure  is  the  same;  pre- 
cisely the  same.  Then  teeth,  set  up  by  these 
equalized  bite=rims,  will  be  of  a  likeness  in 
pressure. 

If  I  hadn't  filed  off  the  bite=rim,  but  had 


IN  Dental  Prosthesis.  157 

gone  on  and  set  up  the  teeth  by  it,   I  would 
have  had  to  grind  them  off  eqtiivalently. 

Unequal  Pressure  Sometimes  Needed 
IN  A  Bite. 

But,  now,  I  wouldn't  have  you  understand 
me  that  stress  should  always  be  the  same  all 
over  the  miouth.  That  is  the  first  conclusion 
new  thinkers  are  apt  to  jump  to.  But  in  many 
instances  the  strain  on  the  tissues  should  be 
unequal  at  different  places. 

For  instance,  we  have  a  mouth  where  the 
gums  are  soft  and  yielding  on  one  side,  and 
hard  and  unyielding  on  the  other  side.  In  the 
absorbing  adjustment  which  always  takes  place, 
more  or  less,  under  artificial  dentures,  especiall}^ 
lower  ones,  after  worn ,  the  softer  side  will  change 
more  than  the  harder;  and  then  finally  the 
teeth  would  strike  together  first  on  the  harder 
side. 

In  this  case,  the  test = slip,  in  testing  the  bite, 
should  hold  the  tighter  on  the  soft  side,  where 
the  most  absorption  is  to  take  place.  We  have 
pairs  of  these  test= slips  of  unequal  thickness 
for  such  cases. 

Similarly,  if  we  had  a  case  where  the  mouth 
was  soft  at  the  rear  and  hard  in  front,  as  is 
often  the  case,  then  our  slides  should  hold  tight- 
er back  there  than  on  the  alveolar  ridge,  in 
front;   and  vice  versa. 

So,  you  see,  the  principle  holds  good  both 
ways.  So  the  simple  pressometer  not  only  en- 
ables us  to  get  equal  pressure  when  we  want  it, 
but  often,  as  importantly,  to  get  unequal  strain 
w^hen  we  need  it. 

This  rule,  however,  is  not  always  practical, 
as  in  temporar}^  cases,  where  the  alveolar  proc- 
ess is  to  become  much  absorbed.  Nor  is  it  ap- 
plicable when  small,   soft  spots  are  supported 


158  GRs;ENJi;  Brothers'  ClinicaIv  Course 

by  hard  ones  near  by.  Nevertheless  its  need 
is  so  frequent  and  use  so  grateful  that  it  might 
be  called  golden. 

Verifying  the  No=Bite. 

We  have  taken  our  still=bite  and  secured 
the  points  essential  to  setting  the  teeth  up  as 
we  want  them;  or  with  close  approximation 
to  it.  That  is,  we  gtiess  we  have  so  taken  it. 
Let  us  now  eliminate  the  guess=factor  from  it. 

To  be  certain  of  results,  we  must  verify  this 
no=bite  before  we  put  it  in  the  articulator;  for 
it  is  within  the  range  of  possibility  that  even 
in  our  tired=rest  short  bite  one  or  the  other  or 
both  of  our  bite=plates  may  have  slipped  on 
the  gums.     It  isn't  probable,  but  possible. 

Also  it  is  possible  that  the  lower  jaw  may 
have  moved  a  little  bit  laterally;  which  would 
give  us  the  same  bad  occlusive  results.  Let 
us,  then,  even  mathematicize  our  proof = test. 

We  have  made  one  no=bite  at  jaw=tire  num- 
ber ten.  That  was  when  we  scribed=marked 
our  lower  bite=rim,  to  trim  it  off  even  with  the 
upper  one. 

Now  if  we  can  have  two  or  three  more  of 
the  same  time=length,  and  the 3^  all  register  alike, 
we  can  know  with  about  mathematical  certain- 
ty that  we  have  the  natural  position  and  rela- 
tion of  the  jaws  at  rest. 

Mathematical  Test  of  the  No=Bite. 

To  make  it,  we  '11  cut,  say,  three  test  V= 
shaped  notches  in  otir  upper  bite=rim;  one  right 
in  the  front=  center,  and  the  other  two — one  on 
each  side — about  the  place  of  the  first  molar. 
Then  give  the  command: 

"Now,  Madam,  I  want  you  to  give  me  an- 
other slow,  short=bite,  just  the  same  as  you  did 
before.     Close  slowly  till  your  lips  touch  lightly, 


IN  Dental  Prosthesis.  159 

and  hold  the  plates  as  closely  together  as  you 
can  without  touching.  You  now  know  how  to 
act  promptly. 

''One,  two,  three,  four,  five,  six,  seven,  eight, 
nine,  ten — snap!  Hold  now,  as  before,  till  I 
mark  again." 

I  this  time  make  a  perpendicular  mark  on 
the  lower  rim  immediately  opposite  the  very 
center  of  each  of  my  test=notches. 

Then  I  take  the  plates  out  of  the  mouth 
and  with  the  Kerr  tracing= stick  I  hot=drop  three 
small  test=knuckles  onto  the  lower  bite=rim  to 
fit  into  the  test  notches  above.  (Here  this  lit- 
tle fine  art  is  shown  practically;  by  first  drop- 
ping a  molten  wee=bit  of  the  roll  tracing=stick 
onto  the  occluding  edge  of  the  lower  rim,  right 
opposite  the  mark  thereon,  and  pressing  it,  a 
little  bit,  into  its  mate=notch  on  the  upper  rim, 
thus  forming  a  test=knuckle.) 

We  make  the  first  pair  of  notch=and=knuckles 
centrally  in  front;  then  one  on  either  side,  one 
at  a  time.  To  prevent  sticking  together,  one 
or  the  other  of  the  plate=rims  is  dipped  into 
cool  water  the  instant  before  the  two  are  pressed 
together  (outside  the  mouth).  We  then  trim 
off  any  little  side  suiplus  about  the  knuckles, 
and  re=warm  and  press  back  together,  to  make 
sure  these  latter  knuckles  don't  interfere  with 
the  exact  coming  together  of  the  rims  between 
them,  which  might  destroy  our  proper  stress, 
established  by  our  pressometer. 

This  fitting  the  knuckles  into  their  notches 
requires  care,  but  is  quickly  done — yes,  in  one 
minute  of  time. 

The  Third  Still=Jaw  Test. 

That  is  twice  now,  we  've  tired  the  jaw  at 
number  ten;  let  us  have  another  tired  bite  of 
the  same  duration;    this  time  to  see  whether 


160  Greene  Brothers'  Clinical.  Course 

or  not  the  test=knuckles  will  jibe  properly  to- 
gether into  their  niatch=notches  in  the  mouth, 
just  as  they  did  out  of  it. 

"Again,  Madam:  One,  two,  three,  four,  five, 
six,  seven,  eight,  nine,  ten — bite!" 

If  the  knuckles  register  into  their  rnate= 
notches  properly,  as  they  will  if  all  has  been 
done  carefully,  we  have  thus  taken  three  no^ 
bites  at  three  different  times,  and  all  just  alike; 
and  no  error  or  doubt  about  it.  We  could  take 
more,  if  necessary,  to  please  a  surprised  Thom- 
as— and  sometimes  do  so. 

Once  I  had  a  "Smart  Alec"  insist  that  I 
couldn't  convince  him  of  the  correctness  of  any 
bite,  or  "no=bite,"  no  matter  what  "proof"  I 
might  show;  as  he  had  been  "fooled  in  bites 
too  often." 

"Well,"  said  I,  "for  your  sake  I  '11  admit 
this  to  be  wrong;  not  uncertain,  but  wrong. 
Would  you  be  satisfied  if  I  could  set  up  a  set 


Fig.  17. 

Fig.  17  Shows  testometers  in  position  between  impression- 
bite- plates.  The  pressure  test  is  made  w^ith  the  "no-bite"  in  the 
inouth,  of  course. 


IN  DiixTAL  Prosthesis.  161 

of  teeth  just  that  wrong,  with  their  cusps  and 
counter=spaces  knuckling  together  hke  these, 
in  the  mouth?" 

"Yes,  I  then  would  be  satisfied,"  said  he. 
So  I  proceeded  to  show  him  by  setting  up  the 
teeth.     And  that  is  what  I  will  now  do  for  you. 

Transfer  No=Bite  to  Articulator. 

We  must  now  transfer  the  no=bite  from  the 
mouth  to  the  articulator,  which  is  to  be  a  rep- 
resentative of  the  real  anatomical,  bone=and= 
flesh  machine  itself. 

But  now,  before  I  leave  the  no=bite,  I  must 
say,  of  course,  in  the  remote  event  that  our 
notches  and  knuckles  should  fail  to  jibe  togeth- 
er in  the  last.  tired=short=snap=test,  it  would  be 
because  one  or  more  of  the  times  the  bite=plates 
(one  or  the  other,  or  both)  did  slip;  or  else  be- 
cause the  lower  jaw  really  did  move,  in  some 
degree,  horizontally.  It  couldn't  be  otherwise. 
Then  I  'd  do  the  notch=and=knuckle  work  over 
till  I  got  ni}'"  no=bite  test. 

Anatomical  Movement  on  the  No=Bite. 

If  I  have  what  I  call  a  "cripple"  case,  I 
make  that  individual  mouth  its  own  articulator, 
in  a  practical  sense.  By  a  "cripple"  case  I 
mean,  for  instance: 

(a)  A  prominent  "jimble=jaw"  of  extended 
mal=protrusion ;  or, 

(b)  One  of  the  reverse,  retrusion;  or, 

(c)  One  where  one  wing  of  the  maxillar}"  is 
much  longer  than  the  other;    or, 

(d)  One  where  there  is  evident  erratic  move- 
ment on  the  "condyle  path,"  on  one  or  both 
sides  of  the  face;  or. 

(e)  One  where  the  hide=and=go=seek  condyle 
socket,  needed  for  the  face=bow  measurement, 


162  Greene;  Brothers'  Clinicae  Course 

is  so  covered  with  tissue  that  it  can't  be  located 
reliably,  as  a  starting=point;  or, 

(/)  One  where  other  nial=formation  or  mal= 
action  is  in  obvious  evidence. 

I  say:  In  such  cases  I  make  each  individual 
mouth  naturally  its  own  articulator,  either  wholly 
or  in  a  very  close  degree;  using  artificial  ma- 
chinery as  a  convenient,  approximate  assistant. 

A  "Cripple"  Mouth  Its  Own  Articulator, 
IN  THE  Finis. 

To  do  this  {i.  e.,  to  make  a  real  automat- 
ic articulation),  I  take  my  completed  no  =  bite 
(sometimes  un=press=measured)  and  trim  about 
one=eighth  of  an  inch  off  the  top  of  the  lower 
bite=rim;  say,  from  the  second  bicuspid  rear- 
ward. Then,  in  the  place  of  this  remj.oved  m^a- 
terial,  I  fill=on  a  facing  mixture  of  plaster  and 
pulverized  pumice=stone  (plaster  one  to  pumice 
three),  with  a  little  extra  fullness  on  top.  Fine 
molding=sand  with  plaster  is  good. 

This  soft=stone,  as  I  will  name  it,  is  frail 
enough  to  be  readily  worn  off  by  attrition. 

The  upper  bite=plate  stays  to  its  place,  and 
(by  my  several  improvements)  likewise  the  low- 
er one,  too.  Of  course,  these  stationary  con- 
ditions are  essential  to  the  operation. 

Now,  with  the  upper  bite=rim  cold  and  rigid, 
I  have  patient  chew=grind  the  two  bite=rims 
together  (the  upper  one  being  hard  modeling 
compound)  with  the  natural  movement  of  her 
jaw,  until  the  soft= stone  facing  is  worn  down 
as  much  as  the  compound  in  front  of  it  will 
permit;  that  is,  to  genuine  anatomical  occlusal 
representation. 

Some  of  my  enthusiastic  anatomical  friends 
may  re=invent  this  little,  but  exceedingly  valu- 
able, Greene=point,  and  name  it  their  "Anatom- 
ical Grind=stone  Method,"  if  they  want  to. 


IN  Dental  PROSxtiEsis.  163 

Occasionally  this  anatomical  abrasion  of  the 
soft=stone  may  be  so  much  as  to  hinder  the 
placing  of  the  no=bite  in  the  articulator  with 
with  convenience  and  certainty.  In  such  a  case, 
I  stick  a  thin  sheet  of  tin=foil  on  the  abraded 
soft=stone,  and  put  a  little  thin=like  plaster  on 
the  foil;  and  then  have  patient  no=bite  straight 
down  on  the  plaster — this  time  without  lateral 
motion.  This  restores  the  lower  bite=rim  and 
enables  correct  arrangement  in  the  articulator. 

I  could  use  modling  compound  instead  of 
plaster  for  this  restoration  of  my  abraded  soft= 
stone,  but  it  might  get  too  hard  and  give  un- 
due pressure,  and  thus  spoil  the  accurate  effect 
of  the  occlusal  abrasion.  Medium  soft  plaster 
is  about  right.  ' 

Understand:  the  only  use  for  the  soft  plas- 
ter restoration  is  for  convenience  and  safety  in 
transferring  the  no=bite  onto  the  articulator. 
When  setting  up  the  teeth  (the  upper)  by  the 
guidance  of  the  lower  bite=rim,  of  course  the 
plaster  level=up  is  first  removed,  then  the  teeth 
occluded  to  the  worn  soft= stone. 

We  '11  carry  out  the  rest  of  our  anatomical, 
occlusal,  guide=bite=abrasion  scheme  to  the  ulti- 
mate anatomical  occlusion  of  the  two  sets  of 
teeth  a  few  minutes  later  on. 

So  far  we  've  only  been  getting  ready  to 
use  our  artificial  articulator  first;  before  apply- 
ing the  newly  discovered  last  act  of  making 
a  cripple  mouth  its  own  articulator. 

(A  class=man  asks:  "Why  isn't  this  a  good 
way  to  take  any  other  than  a  "cripple"  case 
bite  ? "  It  is,  but  it 's  not  often  necessary  where 
our  regular  no=bite  scheme  can  be  accomplished. 

Another  question :  ' '  Why  not  use  some  sort 
of  hard,  thin  wax  base=plate  and  put  modeling 
compound  on  it  for  a  bite=rim?"  That  's  our 
old  way.     You  can  do  it  if  you  can  get  a  well= 


164  Grse;ne  Brothers'  Clinical  Course 

fitting  base=plate;   essential  in  any  bite  method. 

As  for  that,  you  can  do  better  by  swaging  a 
metaUc  bite=plate  and  using  a  modeUng= com- 
pound bite=rim  on  it.  You  can  then,  when  in 
the  articulator,  remove  the  compound  rim  and 
replace  it  with  sticky  wax,  on  which  to  set  up 
the  teeth.  Any  bite=plate  that  will  stay  to  place 
without  assistance. 

But,  if  you  make  the  "mouth  its  own  ar- 
ticulator," the  rim  must  be  of  material  that 
will  stand  the  natural,  automatic  grind=mashing 
maneuver;  which  is  done  first  in  the  bite — ^later, 
on  the  set=up  teeth  themselves. 

Correct  Bites  Till  They  Do  Test. 

If,  in  any  case,  our  no=bite  test  should,  from 
any  cause,  fail,  then  the  remedy  would,  of 
course,  be  to  do  it  over;  or  as  much  of  it  as 
necessary,  until  we  get  the  absolutely  "math- 
ematical" proof  we  need.  But  with  care  from 
the  start  you  '11,  indeed,  seldom  fail  to  make 
the  jibe=test  on  the  first  trial. 

But  right  here  let  me,  before  I  forget  it, 
nm  back  and  suggest  that  in  case  you  shouldn't 
have  time  to  wait  and  make  models,  from  which 
to  take  bite=plate's  impression,  you  can  take 
them  directly  from  the  mouth. 

That  is,  you  can  take  one  set  of  impres- 
sions for  making  vulcanizing  models  later  on, 
by  keeping  them  in  cold  storage  till  ready  to 
make  the  models.  And  then  you  can  take  an- 
other set  of  impressions,  and  take  the  no=bites 
on  them;  and  put  them  likewise  in  cold  water 
till  you  get  ready  to  make  your  models  and 
articulate  your  case,  weeks  or  months  later  on. 

Firm  i\RTicuLAT0R  Important. 

As  to  articulators,  I  will  say:  There  are  some 
good  ones  and  more  bad  ones.     My  objection 


IN  Dental  Prosthesis.  165 

is  to^those  of  needless  complication  and  bulk, 
and  those  that  are  flimsy  and  flexible;  espe- 
cially the  latter. 

I  find  articulators  very  much  like  inlay  ma- 
chines; some  are  perplexingly  ingenious  and 
others  ingenioush^  simple.  And  the  funny  thing 
about  it  is  that  the  good  plain  and  complex 
ones  give  about  the  same  result,  if  properly 
operated,  from  a  tested  no=bite. 

Anyhow  I  can  get  all  the  real  advantages 
in  a  simple,  light  but  strong,  plain,  old=style 
articulator,  by  a  little  improvement,  that  I  can 
make  in  a  few  minutes. 

The  only  exception  is  that  I  can't  open  or 
close  (widen  or  contract)  my  bjte  after  in  the 
articulator.  But  by  my  advance=test  system 
I  never  need  nor  want  to  do  that. 

With  it  I  can  make  all  the  movements  the 
jaw  makes  in  actual  use.  It  is  the  pattern  I 
find  in  use  {minus  my  improvement)  in  nine- 
tenths  of  all  the  dental  offices  I  visit;  hence  I 
use  it  mostly  in  my  demonstration.  But  this 
is  not  condemning  all  others,  at  all. 

The  essential  of  an  articulator  is  that  no 
part  of  it  can  move,  nor  especially  spring,  with- 
out purpose  effort.  The  old  Bon  well  is  partic- 
ularly faulty  in  its  fiimsiness  and  consequent 
liability  to  change  the  bite;  on  account  of  which 
so  many  failures  are  made  that  the  "springy 
old  thing"  has  been  generally  discarded  and 
junk=piled.  And  yet  the  faulty  Bonwell  is  good 
enough  in  the  hands  of  the  few  dentists  who 
persistently  self=train  themselves  in  exceeding 
carefulness. 

To  illustrate  this  important  weak  point,  I 
carry  with  me  an  old  plaindiner  with  its  upper 
jaw  so  weak  as  to  be  sprung  carelessly  and  thus 
change  the  set=up  teeth  from  the  accepted  bite, 
and  i-uin  the  occlusion.     As  the  spring,  by  care- 


166  Greene;  Brothers'  Clinical  Course 

lessness,  is  usually  toward,  the  result  is  to'^cause 
the  teeth  to  strike  together  first^  atjthe|heel, 
when  inserted  in  the  mouth. 

Well,  as  this  fault  applies  to  sojmany  ar- 
ticulators, I  will  show  you  the  consequences 
later  on  in  this  lecture. 

I  will  add  here,  however,  that  as  I  am  not 
pecuniarily  interested  in  articulators,  and  as 
life  is  now  too  short  (at  seventy-two)  to  enter 
the  "anatomical"  arena,  I  have  not  tried  all 
of  them.  But  among  the  simple  modem  ones 
I  have  used  and  seen  used,  with  satisfaction, 
is  the  "Kerr,"  made  by  the  Detroit  Dental 
Manufacturing  Company.  The  untried  ones 
may  he  as  good. 

Articulator  in  Most  Common  Use. 

I  will  here  make  my  demonstration  on  an 
improved  old=fashioned  plain=liner,  because  of 
its  simplicity  with  efficiency  and  because  of  its 
being  most  of  all  in  general  use  among  those 
who  take  my  Course. 

•  In  placing  first  my  lower  model  on  the  lower 
jaw  of  my  articulator,  I  want  its  alveolar  face 
about  on  a  horizontal  plane  with  the  metal  jaw 
under  it.  And  my  ready=made  metal  models 
are  generally  already  so  trimmed.  (They  are 
manufactured  by  the  Detroit  Dental  Manufact- 
uring Company.) 

I  can  use  a  "face=bow"  to  get  the  model's 
forward  distance,  and  in  easy  cases  do  so. 

(Here  the  Snow  face=bow  and  its  applica- 
tions are  shown  when  requested;  also  the  dif- 
ficulties and  uncertainties  in  exceptional  "crip- 
ple" cases.) 

But,  upon'  the  whole,  I  don't  find  it  really 
practical  any  further  than  to  help  in  getting 
the  "average"  of  the  measurement  claimed  for 
the  principle.     Rather  than  ' '  argufy ' '  with  f ace= 


IN  Dental  Prosthesis.  167 

bow  enthusiasts,  I  would  save  time  and  admit 
ignorance  in  its  use.  Some  claim  for  it  infalli- 
bility in  all  cases. 

I  am  content  to  accept  the  average  the  anat- 
omists agree  on  as  to  the  actual  measurement 
of  the  dead.  This  average  measurement,  we 
are  told,  is  ahottt  three  and  a  half  inches;  that 
is  to  say,  from  the  alveolar  ridge  center  in  front 
to  the  center  between  the  two  condyle  sockets 
at  the  rear. 

Then  the  center  of  the  alveolar  ridge  of  our 
lower  model,  in  front,  should  be,  say,  three 
and  a  half  inches  from  the  cross=bar  of  our  ar- 
ticulator. So,  as  a  substitute  for  a  face=bow, 
if  we  have  none,  we  have  a  simple,  little,  nar- 
Tow,  thin,  flat  piece  of  wood,  three  and  a  half 
inches  long,  with  a  little  scallop  in  one  end  to 
fit  against  the  cross=bar. 

To  Fix  Lower  Model  on  Articulator. 

To  adjust  this  model  on  the  articulator  read- 
ily, I  first  la}'  the  latter's  lower  jaw  onto  a  piece 
of  paper  on  the  table;  then  pour  some  thin 
plaster  on  the  paper;  then  set  my  inodel  into 
this  soft  i^laster,  and  apply  my  face=bow  sub- 
stitute. That  is  to  say,  I  set  the  scalloped  end 
of  it  against  the  cross=bar  of  my  articulator, 
and  slide  my  model  to  make  its  alveolar  front 
center  even  with  the  other  end. 

In  case  of  much  protrusion  or  retrusion  of 
lower  maxillary,  I  "make  allowances."  I  might 
and  might  not  come  nearer  to  anatomical  ex- 
actness by  face=bow  measurement.  But  these 
are  of  the  family  of  "cripple"  cases,  for  which 
we  hold  in  our  sleeve  a  last=resort  trick= taking 
card,  after  the  teeth  are  set  to  this  very  close 
approximation . 

x\fter  the  lovx-er  model  has  been  shoved  down 
on  a  plane  with  the  jaw  of  the  articulator  and 


168  Greene  Brothers'  Clinical  Course 

fastened,  as  just  shown,  we  place  the  lower 
bite=plate  onto  it  (the  model);  then  the  upper 
bite=plate  onto  the  lower  one,  with  the  afore- 
said jibing  notches  and  knuckles  as  guides;  and 
next  the  upper  model  into  the  upper  bite=plate. 
Next,  turn  the  upper  jaw  of  the  articulator 
over,  forward,  onto  the  model,  not  quite  touch- 
ing it.  We  want  to  see  daylight  between  them, 
to  be  sure  there  is  no  metallic  strain  on  the 
model  to  tip  it.  Then  we  '11  peep  under  and 
set  the  guide=screw,  and  lock  it  firmh^;  and 
hold  up  our  hand  to  the  avowed  certainty  that 
it  can't  work  loose.  Then  wet  the  back  of  the 
upper  model,  hold  it  down  into  its  bite=plate 
firmly  without  strain  on  articulator,  and  plaster 
it  fast. 

Base=Plates. 

You  are  all  familiar  with  the  various  base^ 
plates  used.  I  presume  most  of  you  take  your 
bites  in  the  same  plate  on  which  you  set  up 
your  teeth,  and  call  it  a  "triahplate." 
.  Well,  if  such  fits  snugly  so  it  will  firmly  hold 
onto  the  gums  without  help,  and  will  not  slide, 
that  will  do.  But,  if  it  should  move  at  all, 
which  it  is  liable  to  do,  especially  on  flat  gums, 
the  result  is  the  same  as  if  a  wrong  bite  had 
been  taken. 

But,  since  I  don't  often  need  to  take  my 
work  off  the  model  to  try  it  in  the  mouth  (sel- 
dom for  occluding  proof,  excepting  in  before* 
mentioned  "cripple"  cases),  I  usually  prefer  to 
use  a  tight=sticking,  permanent  base=plate  on 
my  model,  to  set  my  teeth  onto.  So,  in  flat 
cases  especially,  I  make  one  for  the  purpose 
that  adheres  to  the  model  almost  like  the  skin 
to  my  hand. 


IN  DiiNTAL  Prosthesis.  169 

The  Dip  Method  of  Making  Base-Plates. 

After  removing  the  bite=plate  from  the  mod- 
el, I  dip  the  latter,  metal=jaw  and  all,  into 
melted  ■base=plate  wax,  usually  floating  on  hot 
water.  I  first  moisten  the  model  to  prevent 
the  molten  wax  from  adhering  too  tightly  to 
the  plaster,  or  other  model. 

Most  of  you  are  familiar  with  making  sheet= 
wax  over  bottles  in  this  way.  Those  who  are 
not  may  have  to  practice  half  an  hour  to  learn 
to  thus  dip  melted  sheet=wax  onto  your  models 
for  base=plates. 

Experth^^  dipped  =  on  base  =  plates  have  not 
onlv  the  advantage  of  tight  adherence  to  the 
model,  but  also  of  being  the  thickness  you  want 
your  finished  plate,  and  the  same  thickness  all 
over;    even  including  the  roof  in  deep  arches. 

Then,  expertly  dipped  base=plates  forestall 
scraping  of  plates;  and  scraping  ustially  weak- 
ens a  rubber  or  celluloid  plate.  It  often  causes 
warping,  even  after  worn,  and  breaking,  if  too 
hard.  But  more  about  scraping  later,  in  fin- 
ishing. If  you  use  other  than  a  dipped=on  base= 
plate,  paste  it  fast  to  the  model,  after  it  has 
been  carefully  adjusted  all  over,  to  prevent 
sliding  when  setting  up  the  teeth. 

Setting  up  Teeth  on  Base=Plate. 

Before  we  removed  the  upper  bite=plate  from 
its  model  on  the  articulator,  we  cut  three  very 
small  notches  in  the  top  of  the  lower  bite=rim 
and  wired  it  fast  onto  its  model;  or  else  sealed 
or  clinched  it  fast  with  cleats  of  modeling  coin- 
pound,  to  hold  it  firmly  to  its  right  place  there- 
on. And  that  right  place  was  inade  manifest 
by  closeh^  observing  the  notch  =  knuckle  fit= 
together  of  the  two  bite=rims.  A  mis=jibe  would 
show  the  lower  bite=plate  misplaced  on  its  mod- 
el;  the  equivalent  of  a  mabbite,  you  see. 


170  Grekne  Brothers'  Clinical  Course 

Then  we  dipped  our  base=plate,  made  of 
clean  scrap  sheet=wax,  onto  our  dampened  mod- 
el, by  one,  two,  or  three  dips,  according  to  the 
thickness  we  wanted  our  denture  plate  to  be. 

Now  we  '11  prepare  to  set  the  teeth  onto  our 
smooth,  dipped  base=^plate.  We  '11  make  a  lit- 
tle roll,  or  bar,  of  sticky = wax  about  the  diam- 
eter of  a  large  goose= quill,  and  warm  it  and 
stick  it  onto  the  base=plate  over  the  ridge  of 
the  model.  (Our  sticky = wax  is  composed  of 
three  parts  bee's=wax  to  one  part  of  rosin  and 
g,  little  paraffine,  melted  and  stirred  together 
and  strained  through  cheese= cloth,  into  a  com- 
mon earthen  table= plate,  to  about  an  eighth 
or  a  quarter  of  an  inch  thick.) 

Onto  this  roll  of  sticky=wax  we  11  hurriedly, 
but  approximately,  adjust  the  teeth;  carefully 
heating  the  pins  in  each  tooth  by  the  side  of 
our  spirit  flame,  to  assure  adherence  to  the  wax. 

We  '11  begin  with  the  central .  incisors  and 
get  them  properly  located;  then  work  on  back, 
one  by  one,  to  the  last  molar.  If  a  little  time 
is  important,  this  can  all  be  done  in  two  or 
tliree  minutes.  Then  warming  the  sticky=wax 
and  the  teeth  thereon,  we  close  the  articulator 
and  simply  press  the  approximately  arranged 
teeth  dov/n  onto  the  lower  bite = rim  for  length, 
atid  out  even  with  its  outer  edge  for  prorninence. 
The  fixity  of  the  guide=screw  holds  the  jaws  to 
right  distance  apart,  and,  if  nothing  sprung,  the 
teeth  have  taken  the  precise  position  of  the 
removed  upper  bite=rim.  We  saw  that  in  the 
mouth  and  satisfied  ourselves  then  as  to  its 
show=length  and  fullness- -we  will  not  doubt 
it  now. 

To  thus  finally  adjust  an  approximately  ar- 
ranged upper  set  of  teeth  requires  from  two 
to  three  minutes. 

(The  art  and  manipulation  of  thus  quickly 


IN  Dental  Prostiiesis.  171 

setting~up  teeth  by  a  guide=rim,  regulated  by 
a  guide=screw,  is  shown  in  detail  and  with  spe- 
cial interest  in  our  verbal  Course.) 

The  heavy,  cumbersome,  complicated  artic- 
ulators are  not  the  best  adapted  to  this  work. 
Nor  are  the  weak,  flexible  ones  at  all.  If  you 
use  flimsy  ones,  re=inforce  their  weak  parts. 
Don't  rely  on  even  your  own  carefulness  in 
their  use  without  strengthening  them. 

Trying  Teeth  in  the  Mouth. 

As  I  have  said,  I  never  need  to  do  this  to 
see  how  they  articulate  or  occlude,  excepting 
in  some  "cripple"  cases  which  I  've  mentioned. 
I  couldn't  make  the  pressometer  test  of  strain 
on  the  teeth  as  well  as  I  m.ade  it  on  the  no=bite. 
And,  unless  I  did  do  it,  the  "trial"  wouldn't  be 
reliable,  as  occlusive  evidence,  in  many  mouths. 
On  the  other  hand,  it  might,  by  wrong  stress, 
give  most  deceptive  testimony.  You  have  all 
"been  there." 

But,  should  1  have  a  case  where  I  wanted 
to  try  it  in  the  mouth  for  looks,  or  other  reas- 
ons, I  would,  of  course,  have  to  use  a  stiff  base= 
plate,  instead  of  one  dipped  onto  the  model. 
But  even  then,  in  most  mouths,  it  would  be 
well  to  give  the  model  a  thin  dip=coating  be- 
fore pressing  the  stiff  base=plate  onto  it,  to  hold 
it  firmly.     You  can  paste  it  on. 

Should  you  remove  a  base=plate,  with  set= 
up  teeth,  from  its  model  on  the  articulator 
{from  a  tested  no=bite),  be  sure  to  make  no 
changes  in  the  articulation;  and  be  certain  to 
get  it  back  onto  the  model  exactly  as  it  was  be- 
fore removal.  A  failure  to  do  this  would  be 
the  equivalent  of  a  wrong  bite.  And  doubtless 
all  of  3^ou  have  had  man}^  a  ' '  wrong  bite ' '  from 
this  source;   in  flat  mouths,  especially. 

You  can  change  the  position  of  the  front 


172  Grei'NE  Brothers'  Clinical  Course 

teeth  as  you  please,  even  after  setting  them 
up  to  their  opposing  guide=rini.  And,  to  ap- 
pear r  atural,  they  often,  if  not  generally,  should 
be  more  or  less  irregularly  spaced  and  stationed. 
Only  beware  of  any  alteration  in  the  length  of 
the  jaw  teeth,  after  once  set  up  to  a  Greene 
no=bite.  They  are  the  fixed  comer=stones  of 
the  tested  relation  of  the  natural  jaws. 

But  as  to  the  front  teeth:  You  can  set, 
or  re-set  them  higher  or  lower.  You  can  space 
them  apart  as  far  as  you  wish;  lean  them  out, 
or  in,  or  turn  them  around,  in  the  sticky = wax. 
You  can  regulate  or  irregulate  them  at  will,  so 
long  as  you  don't  change  the  set  guide = screw 
nor  disregard  it. 

Side  Remarks — Prosthetic  Quackery. 

And,  my  dear  doctors,  I  will  here  beg  par- 
don for  a  little  side  lecture,  to  insist  that  by 
far  the  most  dentists  set  up  their  teeth  too  reg- 
ular to  look  natural  or  artistic.  The  distaste- 
ful custom  is  to  use  white  teeth  and  set  them 
up  for  the  mouth  to  imitate  buttons  on  a  paste= 
board,  or  tombstones  in  a  national  cemetery. 

The  result  is  that  most  wearers  of  artificial 
teeth  look  like  ghosts  grinning  through  m.oon= 
shine. 

It  is  as  much  of  a  professional  disgrace,  or 
more,  for  ethical  dentists  to  let  their  foolish  pa- 
tients force  them  to  do  inartistic  work  and  per- 
form unethical  operations,  as  it  is '  for  an  ad- 
mitted unethical  quack  to  do  the  same  thing 
through  ignorance  or  greed.  Hard  to  sa}^  but 
needs  no  proof. 

Dental  ethics!  Humph!  I  have  known  scores 
of  the  so-called  "best  men"  to  argue  learnedly 
and  truthfully  with  their  patients  against  the 
quackery  and  wrong  of  sacrificing  natural  teeth 
and  then  finally  give  up  and  sacrifice  them  them' 


rx   Dkntal   I'rosthksis.  173 

selves;    to  do,  I  niight  say,  their  part  to  teach 
that  their  calling  is  no  profession  after  all. 

Dental  ethics  ?  Almost  every  week,  and  fre- 
quently oftener,  I  see  mouths  of  good,  or  fairly 
good,  natural  teeth  cycloned  to  make  room  for 
little,  white,  glossy  substitutes,  to  be  jammed 
closely  together  in  straight,  even  button = rows. 
Nor  do  I  have  to  go  to  an  "advertising  joint," 
or  "  artificial= tooth  shop,  "  to  see  this. 

Then,  is  it  any  wonder  that  the  really  most 
difficult  and  highest  art  in  dentistry  is  sunken 
to  the  lowest  grade  in  dental  trade,  when  a  ma- 
jority of  even  college  graduates  will  thus  "ac- 
commodate" the  "whims  and  ignorant  prejudices 
of  their  so-called  patients  ? 

Then,  for  the  dignity  of  yotir  almost  sacred 
calling,  both  select  and  set  your  teeth  in  har- 
mony with  physiognoni}^  and  age;  yes,  age  of 
your  patrons.  Stand  in  front  of  the  dignitv  of 
your  scientific  profession;  at  least,  as  an  eth- 
ical scientific  horse=shoer  does.  You  can't  hire 
him  to  shoe  even  a  mule  wrongly;  nor  scare 
him  with  threats  to  go  to  his  quack  competitor. 

It  is  legitimate  license  to  improve  features, 
but  you  w^ill  never  do  it  by  such  contrasts  and 
inharmony  as  little,  white  teeth,  evenly  set  in 
an  old  grandma's  mouth. 

You  might  as  well  put  a  short  white  skirt- 
let,  white  frilled  pantelettes  and  sailor  hat  on 
her,  and  braid  her  hair  wqth  flowing  ribbons 
down  behind,  to  "make  her  look  young." 

Now,  do  you  know  of  any  professional  mod- 
iste who  would  risk  her  reputation  and  dis- 
grace her  calling  like  that?  Wouldn't  she  tell 
a  patron  with  such  .  taste  to  go  to — to  some 
quack  for  accommodation? 

Wax  up  the  Upper  Case. 

When  our  upper  teeth  are  set  up,  either 
stififly  to  conform  to  our  lower  guide=rim,  as  it 


174  Greene;  Brothers'  Clinicai.  Course 

would  be  in  a  plain,  level  case;  or  more  artistic, 
to  harmonize  with  features  and  age,  in  a  differ- 
ent case — we  wax=up  and  cool  well  before  set- 
ting up  the  lower  ones  to  them. 

If  our  impression  has  been  properly  taken 
for  the  fullness  of  the  lip  and  cheeks  (which  is 
especially  practicable  in  using  the  Greene  trays 
with  movable  handles),  the  model  has  a  pro- 
jecting bench  to  guide  and  regulate  the  upper 
edge  of  our  waxing.  And,  as  the  cutting  ends 
of  the  teeth  regulate  the  fullness  down  there, 
it  is  but  a  small  matter  to  wax='Up  a  case,  using 
the  sticky=wax  formula.     (Index  S.) 

I  will  only  advise  you  again  to  forestall 
scraping  and  filing  your  vulcanite  and  celluloid 
plates,  by  scraping  and  flowing  your  wax.  You 
not  only  save  time  and  material,  but  reduce 
tendency  to  warping  —  and  maybe  breaking, 
should  you  carelessly  get  rubber  too  hard. 

Set  up  the  Lower  Teeth. 

Our  upper  teeth  are  set  up  to  the  lower 
bite=rim  and  waxed  just  as  we  want  the  dent- 
ure to  be,  including  roof = thickness.  It  is  tight 
to  its  model  and  can't  move  by  accident. 

Now  we  '11  remove  the  bite=plate  from  the 
lower  model  and  put  thereon  a  base=plate,  in 
any  way  we  choose ;    but  tightly  on . 

On  this  we  '11  place  sticky=wax,  and  again, 
hurriedly,  arrange  the  lower  teeth  to  approx- 
imately fit  to  the  seUoTid'waxed  upper  ones. 

Our  set  guide=screw  and  its  lock  are  still  on 
duty,  holding  the  models  exactly  in  the  relation 
the  natural  tissues  were  when  ive  took  our  no=bite 
and  proof 'tested  it.  Also  our  articulator  is  stable 
and  can't  change  by  our  carelessness. 

Peeping  under  and  seeing  that  the  end  of  the 
set=screw  is  close  up  against  the  opposing  jaw  of 
the  articulator,  we  '11  now  carefully,  yet  quickly, 


IN  Dental  Prosthesis.  175 

adjust  the  lower  teeth  up  to  match  against  the 
upper  ones,  just  as  v/e  want  them  to  be.  T  say 
"quickl}^"  because,  if  they  are  single  teeth,  sev- 
eral of  them  may  be  pushed  up  together. 

We  stick  one  finger  up  through  the  articu- 
lator frame  to  brace  the  teeth,  or  maA^be  push 
them  outward,  while  we  press  them  to  place  with 
another  finger,  or  thumb,  of  the  other  hand — 
frequently  all  in  less  time  than  I  tell  it. 

If  the  teeth,  upper  or  lower,  are  in  gum 
sections,  they  can  be  ground  up  and  set  in 
one=fourth  the  time  usually  required  by  the 
old  way  of  grind=and=try  in  common  use.  From 
the  first  touch  in  jointing,  the  block  has  some- 
thing to  rest  against  and  to  hold  it  back  to  its 
exact  same  place,  after  each  removal. 

That  is,  in  setting  the  upper  ones,  they  rest 
squarely  down  onto  the  lower  level  bite=rini; 
and,  in  setting  the  lower  ones,  they  rest  against 
the  solid,  waxed,  fixed  upper  teeth;  and,  of 
course,  as  naturally,  or  "anatomically,"  as  the 
"pattern"  used  will  admit  of. 

"Watch=Word  in  Setting  up  Teeth. 

If  I  were  to  constiTict  a  guard=word  in  the 
art  of  setting  up  teeth,  I  would  make  it:  "  Watch 
your  guide= screw,  and  don't  strain  your  articulat- 
or s  jaws.''  How  many,  many  failures  from  dis- 
regarding this  half =sacred  guard=word ! 

Wax=up  the  Lower  Set. 

With  the  lower  teeth  properly  set  to  occlude 
with  the  upper  set,  we  go  on  and  wax  the 
former  as  we  did  the  latter.  And  in  this  case, 
too,  we  '11  conform  the  wax  as  nearh^  as  possi- 
ble to  what  we  want  the  plate  to  be,  to  avoid 
detrimental  scraping. 

If  we  expected  to  try  the  lower  teeth  in  the 
mouth,  after  set  up,  we   'd  leave  as  much  as 


176  Gre;e;nii;  Brothers'  Clinical  Course 

possible  of  the  heavy  lead=weighted  compound 
i)ite=plate,  and  put  our  roll  of  sticky=wax  on 
Ihat:  For  weight  is  indeed  greatly  helpful  in 
holding  the  case  down  to  its  proper  place,  while 
being  tried  in;  especially  where  there  is  little 
or  no  alveolar  ridge,  and  no  suction. 

Where,  in  any  case,  I  expect  to  try  waxed=. 
up  lower  teeth  in  the  mouth,  on  flat  gums,  I 
first  lay  several  sheets  of  tin,  or  lead,  on  the 
model,  under  the  w^ax,  or  other  material,  into 
which  the  teeth  are  to  be  set;  yes,  quite  a  bar 
of  lead,  if  room  for  it. 

Say,  doctors,  when  you  get  to  using  weight 
in  lower  bite=plates  and  base=plates,  you  11  feel, 
and  do,  as  the  tenants  of  the  Duke  of  Arg3de 
once  did. 

He  advertised  for  the  best  way  to  make 
them  grateful  and  to  praise  him;  and  the  re- 
sult was  that  he  put  up  back=scratching  posts 
at  close  convenience  all  over  his  estate.  Then 
all  the  people  scratched  their  backs  every  day 
and  gratefully  rejoiced  aloud:  " Bless=ed  he  the 
Duke  of  Argylef 

Yea,  doctors,  in  severely  needful  cases  3^ou 
may  catch  their  spirit  and  put  up  great  sound= 
boards  to  re=echo:  "Blessed  be  the  cranky  old 
farmer  dentist  froin  the  'Show=me'  State! '^  If 
you  don't,  you  '11  be  ungrateful  for  this  $ioo 
pointer. 

The  Important  Tongue=Rest  Scallop. 

One  of  the  most  important  points  in  a  lower 
set  of  teeth- — especially  "Where  there  is  little  or 
no  alveolar  ridge,  but  moving  tissue  in  its  place 
■ — is  a  good  tongue=rest.  That  is,  the  lingual  side 
of  the  j)late  should  be  so  scalloped  out,  from 
the  teeth  down  to  the  lower  edge,  as  to  furnish 
the  tongue  a  frictional  rest,  on  which  to  exert 
force  to  hold  the  denture  down  in  chewing; 
especially  in  biting  in  front. 


IN  Dental  PROsTiiRras.  177 

To  make  room  for  this  accommodating  lin- 
gual support,  the  jaw  teeth  should  be  some- 
what high,  or  long;  and,  that  they  may  be  so, 
the  touching  ones  above  must  be  correspond- 
ingly short.  The  rule,  then,  is  to  range  the 
upper  molars  rather  upwards  and  make  the  last 
one  about  as  short  as  you  well  can;  then,  of 
course,  bring  up  the  opposite  lower  ones  to 
correspond. 

The  exception  w^ould  be  when  the  upper  jaw 
teeth  need  to  be  long,  to  hold  the  cheeks  out. 
But,  nevertheless,  long  molars,  especially  long 
last  =  molars,  are  detrimental  to  comfortable 
wearing  of  upper  dentures,  anyhow. 

Dr.  Geo.  A.  Wilson,  the  eminent  prosthetic 
specialist,  of  Cleveland,  Ohio,  contends  that  the 
up=tum  in  the  range  of  an  upper  set  of  teeth 
should  be  confined  to  the  final  molar;  leaving 
the  rest  on  a  plain,  occlusal  line.  And,  strictl}^ 
speaking,  philosophically  he  is  probably  correct. 
I  can't  say  anatomically  correct,  for  anatomies 
vary  much  in  this  respect. 

The  Final  "Joker"  in  Lower  Cases. 

There  are  some  cases  where  the  lower  teeth, 
for  one  or  more  reasons,  can't  be  made  long 
enough  to  provide  ample  space  for  a  sufficient 
cut  =  away  for  such  frictional  tongue  support. 
In  such  cases,  I  come  to  the  rescue  with  a  uni- 
versal, ne  plus  ultra  ''joker.'' 

This  consists  of  a  narrow,  lateral  addition 
to  the  lingual  edge  of  the  lower  plate  on  both 
sides  of  the  mouth — not  in  front. 

B}^  vulcanizing  (if  a  rubber  plate)  such  an 
extension  to  the  plate,  at  right  angle  with  its 
lingual  walls,  and  then  scalloping  out  some  from 
both  the  wall  and  extension,  a  sufficient  tongue= 
rest  can  be  made,  in  almost  any  case,  to  hold 
down  a  lower  denture;  even  if  it  had  no  other 


178  Greijne:  Brothers'  Clinicai^  Course 

means  of  retention.  Of  course,  the  extension 
should  be  made  and  the  scraping  done  in  the 
wax;  never  much  in  the  vulcanite  plate. 

However,  in  swaged  or  cast  metal  plates,  pro- 
vision should  be  made  for  the  joker  first  in  the 
impression,  and  consequently  on  the  model;  a 
stunt  requiring  skill,  experience  and  persistence. 

Another  Reason  for  the  Joker. 

Another  valuable  advantage  in  the  joker, 
other  than  its  providing  means  for  tongue  force, 
is  that  it  adds  area  to  atmospheric  contact  and 
thereby  helps  to  give  the  denture  more  so= called 
"suction."  But  beware  of  adding  depth  to  the 
plate's  edge,  which  was  settled  in  the  impres- 
sion, in  the  outstart.     (See  Index  V.) 

It  must  extend  laterally,  and  sometimes  a 
little  angling  upward,  to  accommodate  a  roll  of 
soft,  moving  tissue  imder  the  tongue. 

When  the  joker  is  properly  adjusted,  it  sets, 
in  normal  cases,  down  onto  and  into  the  sublin- 
gual saliva  bed,  ever  present  in  healthy  mouths, 
giving  the  plate  the  action  of  a  duck's  web= 
foot  in  a  mud=puddle.  Without  it,  such  a  plate 
might  be  as  a  chicken's  webless  foot,  easily 
working  up=and=down  in  water. 

The  joker  should  extend  in  length,  say,  from 
about  the  anterior  of  the  first  bicuspid  to  the 
posterior  of  the  second  molar;  and  in  width, 
say,  one=eighth  to  three= sixteenths  of  an  inch 
in  the  center,  rounding  off  gradually  to  the  ends. 

While  I  advise  usually  about  this  width  for 
this  tongue=rest  extension,  I  have  put  them  on 
twice  as  wide,  with  little  or  no  discomfort  to 
the  wearer.  '_  \    l_ 

In  one  case,  a  dentist  misunderstood  '  me 
and  made  the  extension  half  an  inch  wide. 
His  report,  a  month  later,  was  that  his  patient 
* '  kicked  like  a  bay  steer  for  ten  days' ' ;   but  aft- 


IN  DuNTAL  Prosthesis.  179 

er  he  had  "cured"  ("tanned")  her  mouth  with 
white=oak=bark  ooze,  it  got  well;  and  "the  plate 
sucked  down  like  a  goose's  foot  in  mire." 

The  Joker  a  New  Idea. 

The  idea  of  a  tongue  scallop  is  not  wholly 
new,  though  the  scheme  never  has  been  prac- 
tically introduced  to  much  extent  until  this 
private  Course  of  Instruction  has  been  before 
the  dentists  in  a  number  of  States,  mostly  in 
the.  far  West  and  mid=West;  now  about  ten 
years. 

But  the  idea  of  a  lateral  extension  to  the 
lingual  rim  of  a  lower  denture,  to  set  onto 
and  into  the  saliva  pool  under  the  tongue,,  and 
thereby  cause  suction,  and  to  furnish  leverage 
for  the  tongue  for  mechanical  power,  is  original 
in  this  Course,  so  far  as  I  know. 

iVnd  I  remember  that  it  took  years  to  de- 
velop active  courage  from  the  inspiration  to 
warrant  a  trial  of  the  theory.  And  I  remem- 
ber how  a  few  sore  mouths  almost  frightened 
me  for  a  while  away  from  this  most  practical 
of  simple  prosthetic  improvements. 

It  is  a  simple  matter  to  scoop  out  tongue= 
rest  room  in  modeling  compound  or  wax;  and 
no  difficult  one  to  add  the  joker  in  wax  in 
**waxing=up."  But  care  must  be  taken  to  do 
it  all  philosophically;  and  especially  to  finish 
so  as  to  leave  no  roughness  whatever. 

And  even  at  the  best  the  mouth  will  some- 
times rec[uire  astringent  treatment,  taking  time 
to  "tan"  the  parts  so  as  to  immtine  them  from 
frictional  soreness. 

Among  the  numerous  astringent  remedies  I 
have  used  to  treat  sore  mouths  and  "tan"  the 
membrane  to  immune  it  from  tenderness,  I 
have  found  nothing  less  disagreeable  nor  more 
successful  than  simple  oak=bark  ooze;    that  is, 


180  GrkExXE  liRoTiiERs'  Clinical  Course 

reduced  tea  from,  preferably,  white=oak  bark, 
with  a  very  little  essential  oil  of  some  sort  in 
it  to  prevent  fermentation. 

But,  withal,  the  joker  is  the  card  that  wins, 
even  when  all  others  fail,  to  hold  a  lower  plate 
in  place  sufficiently  for  practical  use.  (In  five 
years  a  thousand  men  will  probably  claim  its 
invention.) 

But  don't  get  the  idea,  as  some  have  done, 
that  my  joker  is  an  attachment  to  the  plate. 
It  is  simply  an  extension  of  the  same  material. 

The  Lateral,  or  "Sheep=Bite," 
Movement. 

Well,  here  we  have  a  full  set  of  real  teeth 
we  've  set  up  by  our  no=bite  rims  in  this  Old 
Plain=,Line  Articulator.  I  use  it  for  its  sim- 
plicity and  popularity. 

We  first  set  the  upper  ones  to  the  lower 
bite=rim.  Then  we  set  the  lower  ones  to  the 
upper  ones.  They  come  together,  as  a  whole, 
just  exactly  as  our  no=bite  rims  representing 
them  did,  "compensating  curve"  and  all. 

But  so  far  we  have  only  a  square,  perpen- 
dicular strike;  at  least,  without  any  known  close= 
occluding  horizontal  fit.  But,  in  crush=grind- 
ing,  the  lower  jaw,  you  know,  has  a  little  lat- 
eral motion ;  sometimes  nicknamed  the  ' '  sheep= 
bite,"  and  the  "quid=bite." 

While  this  lateral .  motion  is  never  as  ex- 
treme in  the  mouth  as  is  generally  shown  as  a 
possible  movement  of  patent  articulators,  it  is 
always  there,  to  some  extent,  in  unimpeded 
natural  masticator}^  action.  And,  of  course, 
artificial  teeth  should  be  adjusted  to  accommo- 
date the  full  natural  side=grinding  action.  The 
wearer  will  seldom  get  the  best  without,  say, 
an  eighth  of  an  inch  sideways  play. 

Now,  the  question  is:  How  best  to  get  this 
natiu'al,  lateral  motion  in  an  artificial  denture? 


IN  Dental  Prosthesis.  181 

The  claim  for  numerous  articulators  on  the 
market  is  that  they  impart  this  and  all  other 
natural  movements  exactly  to  the  artificial  den- 
ture, including  the  anatomical  relations  of  the 
teeth.     This  is  indeed  well. 

But  granting  the  competency  of  the  ma- 
chinery itself,  there  is  a  problematic  combi- 
nation of  ticklish  factors  in  the  way  of  prac- 
tical application.  So  the  exact  transference 
"depends." 

It  depends  on  (a)  whether  or  tiot  the  dent- 
ist has  the  exact  natural  bite — very  doubtful 
by  usual  methods;  and  ib)  whether  he  has  this 
exact  natural  bite  on  the  articulators  exactly 
as  it  was  when  tested  in  the  mouth;  and  {c} 
whether  he  knows  the  exact  movements  of 
that  particular  jaw;  and  (d)  whether  he  sets, 
his  machinery  exactl}^  to  those  (probabl}^  vary- 
ing and  erratic)  movements. 

I  don't  mention  these  problematic  points 
to  hyper=  criticise  claimants  for  perfect  anatom- 
ical articulation  and  occlusion,  who  so  seldom 
give  all  these  essential  facts  in  their  case.  I 
do  it  to  put  you  on  your  guard  in  the  use  of 
any  articulating  device. 

Whether  time  or  not,  I  '11  here  assume  they 
can't  (for  I  can't)  always  organize  all  these 
factors  into  practical  operation  for  the  exact- 
ness claimed.  We  '11  then  go  on  and  do  at 
least  the  next  best  thing,  under  the  circum- 
stances. We  '11  make  the  closest  approxima- 
tion that  artificial  machiner}'  can  provide,  and 
then  make  the  jaw  itself  its  own  articulator 
in  the  finis. 

The   Common   Old   Plain=Line   Articulator 
Improved  for  Anatomic  Work.  ~ 

I  have  here  an  old  plain=line  articulator  that 
I  have  so  improved  as  to  give,  I  think,  as  ap- 


182  Greene;  Brothers'  Clinical  Course 

proximately  the  average  anatomical  movements 
of  the  natural  jaw  as  any  I  've  seen. 

You  '11  laugh  when  you  see  the  plain ,  humble, 
slandered  old  lady  in  fashionable  dress  and  in 
service  on  the  modem  anatomical  stage.  Why, 
she  '5  joined  the  Lecture  Bureau!  My!  isn't  it 
a  bouquet* deserving  achievement  to  have  "dis- 
covered" the  mud=covered  old  diamond! 

See  here,  doctors,  with  this  native  cross=bar 
she  shows  her  plain  open^and=shut,  unassum- 
ing position;  her  straight  up=and=down  way  of 
doing.     That  's  "before  taken." 

Now  look  again!  By  a  simple  twist  of  my 
fingers  I  '11  remove  her  old  tight= jacket  cross* 
bar  and  insert  a  freer  (smaller)  base  of  action; 
a  simxple,  common  8=penny  nail  that  I  found 
on  the  sidewalk,  trampled  in  the  dust  of  hu- 
miliation by  the  thoughtless  multitude — only 
an  8=penny  nail,  rusty  from  ill=treatment,  neg- 
lect, and  inactivity. 

But  humble  as  the  common  nail  is,  it  en- 
ables Madam  Old  Plain=Liner  to  sweep  the  ana- 
tomical horizon  to  the  right  and  to  the  left  in 
graceful,  competitive  waltz. 

What  an  honor  to  the  down= trodden  old 
nail  to  have  enabled  the  long=guyed  old  Madam 
to  impart  such  lateral  "sheep=bite"  benefit  to 
toothless  humanity! 

Well,  let  's  stop  praise,  and  ask  the  old 
thing  to  prove  she  's  from  Missouri  by  "show- 
ing" us.  I  '11  be  her  humble  servant.  Watch 
me.  I  '11  baptize  her  upper  jaw,  teeth  and  all, 
"into"  cold  water.  Then  I  '11  give  the  teeth 
of  her  lower  jaw  a  warm  reception  over  our 
cheerful  spirit=lamp  till  they  are  ready  to  move 
in  the  right  direction. 

See !  Now  I  clasp  my  whole  left  hand  firm- 
ly over  her  cold  upper  jaw  and  hold  it  tightly 
all  around;    then  fully  clasp  her  more  tractable 


IN    DdnTAL   PROSTIieSIS.  1^3 

lower  jaw,  in  the  same  way,  with  my  right 
hand — that  Ufted  the  lost  nail  from  the  mire 
and  the  clay  to  glorious  usefulness. 

With  the  upper  teeth  cold  and  set  in  stolid 
firmness,  and  the  lower  ones  warm  and  willing 
to  yield  to  their  superiors,  under  pressing  cir- 
cumstances, I'll  give  the  command  to  "Side= 
wiggle!"  And  all  on  a  sudden  the  teeth  be- 
low have  "exactly"  waltzed  themselves  toward 
those  above  them,  to  practical  anatomical  jux- 
taposition—if v/e  've  watched  the  set=screw  and 
haven't  bent  the  metal  jaw.  We  now  have 
lateral  occlusion,  also. 

But  the  action  of  Madam  Plain=Liner  isn't 
up=to=date  yet.  She  must  now  set  her  face  in. 
another  direction.  I  '11  further  help  her  up  in 
the  popular  anatomical  world.  Watch  me  close 
this  time. 

The  Forward  Bite  Movement. 

I  '11  take  a  small,  parallel=round  rat=tail  file^ 
the  size  of  a  6=penny  nail,  and  make  a  small 
"condyle  path,  "  or  slot,  running  out  from  each 
one  of  the  four  cross=bar  holes,  at  regulation 
angle;  on  both  sides  of  the  articulator,  of  course. 

These  slots  extend  out  about  one=sixteenth 
of  an  inch  from  the  main  cross=bar  holes;  those 
in  the  upper  jaw  extending  forward  and  those 
in  the  under  jaw  rearward.  The  two  condyle 
slots  (a  pair)  together  in  action  give  the  lower 
jaw  a  range=reach  of,  say,  one=eighth  of  an  inch; 
or  more,  if  wanted. 

So  with  a  still  smaller  nail,  a  6=penny,  that 
will  move  in  the  newly  provided  "condyle  path,'* 
she  can  now  reach  out  and  bite  end=to=end  on 
her  front  teeth — ^like  "Suz=an  Moriah"  could. 

We  peep  under  and  see  that  our  "compen- 
sating curve,"  made  for  other  purposes,  and 
incidentally  for  this  occasion,   is  intact.     The 


184  Greenf,  Brothers'  Clinical  Coursi; 

rear  molars  still  hit  together  "automatically." 
By  further  extending  our  little=nail  slots,  Mad- 
am Plain=Liner  could  make  just  as  exaggerated 
protiaiding  movements  as  any  of  her  competi- 
tors. But  she  doesn't  care  to  distort  merely 
to  show  off  possibilities. 

Each  Mouth  Its  Own  Articulator  in  the 
Finis  Further  Illustrated. 

Well,  now,  if  we  want  the  exquisite  of  nat- 
ural anatomical  occlusion,  we  '11  first  finish  the 
upper  set;  and  then  take  the  lower  set  (which 
stays  down  from  muscle  =  trimmed  non  =  resist- 
ance, weight,  tongue  power,  and  atmospheric 
pressure)  and  adjust  the  teeth,  in  the  mouth, 
to  the  finished  upper  ones  by  "  each=mxOuth=its 
own=articulator  =  in  =  the  =  finis'''  action  —  to  be 
shown  a  few  minutes  later  on. 

If  we  can  control  the  one  seldom4hought=of, 
all=important  matter  of  strain  in  the  lateral, 
sheep=bite  action,  our  anatomical  occlusion  will 
be  mighty  close  to  perfection.  And  this  is  what 
we  propose  to  do. 

Class  Requests  Difficult  and  "Cripple"= 
Case  Articulation  Again  and 
Further  Explained. 

Well,  to  review:  In  cases  of  pronounced 
deviation  fromi  the  normal  (as  in  extreme  pro- 
trusion or  retrusion,  where  even  the  "average" 
is  evidently  out  of  the  question;  where  the 
three=and=a=half=inch  measuring= stick  wouldn't 
make  good,  nor  the  condyle  socket  be  findable, 
for  face=bow  application)— we  can  resort  to  our 
already  mentioned  process  of  real,  natural  auto- 
matical articulation;  that  is,  to  make  the  mouth 
itself  its  own  articulator  in  the  end. 

We  can  take  our  regular  non=moving  no= 
bite  on  a  modeling=compound  bite=plate;  which 


IN  Dental  Prosthesis.  185 

would  give  at  least  a  close  approximation  to 
the  trtie  bite;    probably  a  correct  one. 

We  'd  then  soapstone  the  occluding  edges 
of  the  rim  to  prevent  adhesion,  and  warm  the 
lower  one  slightly,  so  as  to  mash  to  the  upper 
one,  not  warmed;  or  to  the  upper  teeth,  if  there, 
natural  or  artificial. 

Then  we  would  quickly  put  the  bite=plates 
into  the  mouth  and  have  patient  actually  chew 
on  them  in  all  directions.  This  would  mash 
the  soft  lower  rim  off  fairly  close  to  the  way 
the  teeth  should  be  set  up. 

Next  we  would  place  the  bite,  as  a  whole, 
in  the  articulator  in  a  way  to  see  it  make  as 
nearly  as  possible  the  same  movements  the  jaw 
made  in  mashing  off  the  lower  bite=rim. 

In  some  cases  I  'd  face  my  lower  bite=rim 
with  soft= stone  (plaster  one  to  pumice= stone 
three)  for  easier  abrasion.     (Index  S.) 

If  patient  had  natural  teeth  above,  we  would 
use  a  model  of  them;  if  artificial  ones,  either 
a  model  of  them  or  the  denture  itself,  in  the 
articulator. 

In  this  kind  of  work  it  is  best  to  use  mod- 
eling composition  in  holding  the  models  in  the 
articulator,  so  that,  if  necessary,  it  may  be  soft- 
ened in  the  slow  adjustment,  sometimes  inev- 
itable in  articulating  bites. 

We  'd  then  set  our  upper  teeth  to  the  lower 
bite=rims,  to  its  anato  fine  ally  mashed=off  or  worn= 
off  surface,  carefully.  Then  set  up  the  lower 
to  the  upper  ones,  as  wanted,  anatomatically, 
of  course.  The  teeth,  set  up  in  this  way,  must 
have  very  close  approximation  to  their  needed 
positions. 

We  would  then  wax  up  our  case,  not  for- 
getting our  tongue=rest  arrangements;  and  cool 
both  plates  while  3^et  on  the  articulator.  Then 
take   them  off  the   articulator  and   warm   the 


186  Grei^nf;  Brothers'  Clinical  Course 

lower  teeth  slightly  over  a  hand  =  spirit  =  lamp 
flame,  just  enough  to  render  them  movable  un- 
der some  pressure,  in  their  waxed  environment. 

Then  quickly  put  the  plates  into  the  mouth 
and  have  patient  go  through  all  the  chewing 
movements,  actually  on  the  teeth  themselves,  for 
adjustment.     This  is  the  ''finis.''' 

Barring  the  stress  feature  (always  contain- 
ing an  element  of  guess=work  without  the  press- 
ometer),  this  will  give  a  practical  "automatic" 
articulation;  especially  if  the  upper  set  is  fin- 
ished before  the  chewing  adjustment  is  made. 

It  is  very  particular  work  to  use  the  press- 
ometer  on  the  waxed=up  teeth.  For  then  the 
reduction  for  the  over= strain  must  be  made  by 
warming  them  and  pressing  dov/n  on  them  to 
exactness,  while  warm,  in  their  wax  investment; 
instead  of  cutting  or  filing  oft"  the  compound, 
as  shown  in  demonstrating  our  pressometer. 

In  taking  a  bite  for  an  auto=articulation  like 
this  (if  in  absence  of  the  pressometer),  it  is 
best  to  soften  the  bite=rim  well  and  bite  lightly, 
if  over  soft  tissues,  to  avoid  getting  the  teeth 
too  long,  in  the  first  place. 

There  are  many  little  varying  details,  es- 
pecially in  these  unusual  cases,  that  you  will 
have  to  work  out  and  apply  yourselves.  But 
the  sum=total  of  the  operation  is  to  make  each 
individual  mouth,  in  difficult  cases,  to  be  prac- 
tically its  own  articulator.  And,  to  do  this, 
you  11  have  to  take  some  pains  to  train  your 
patrons  how  to  do  their  part;  and  have  due 
patience  with  their  awkwardness.  You  have 
gained  the  victory  when  you  can  do  this. 

While  somiC  of  this  fine=point  work  would 
be  superfluous  in  plain,  easy  cases,  it  's  never- 
theless mighty  handy  to  resort  to  ' '  every=mouth= 
its=own=articulator  "  in  unusual  ones. 

But  for  Old  Greene's  sake,  now,  don't  get 


IN  Dental  Prosthesis.  187 

this  mixed  up  with  the  common  old  "try=it= 
in=the=mouth "  uncertainty,  where  light,  guess= 
trimmed  lower  bite = plates  ? jump  up  and  aroimd 
like  mice  in  a  training=school,  preparing  for  a 
pussy  =  cat  invasion.  Bite=plates  and  set  =  up 
teeth  must  stay  in  place,  to  make  good  in  the 
finis. 

When  understood,  there  's  little  kind=ship  be- 
tween the  two  last=resorts. 

I  '^'  (N.  B. — ^This  is  all  shown  in  detail,  on  the 
articulator,  in  the  verbal  Course.) 

New  Way  to  Take  Test  No=Bites,  in 
NO'Handle  Bite=Trays. 

It  has  taken  me  many  years  to  invent  and 
put  into  practice  what  I  'm  now  going  to  show 
you.  It  is  a  combination  impression=and=bite 
tray,  with  short,  movable  handles. 

With  the  handles  on,  I  take  my  impressions 
in  modeling  compound,  to  the  finish  test,  just 
as  shown  in  my  first  lecture. 

^"'^ After  the  test,  I  cool  them  thoroughly  in 
the  mouth;  then  remove  them  therefrom  and 
cool  again,  and  also  remove  the  handles.  Then 
add  a  modeling=compound  bite=rim  onto  the 
metal  tra}^  on  reverse  side  from  impression. 

-,The  test  impressions  are  now  also  bite=plates. 
We  '11  put  the  upper  one  in  and  out,  as  such, 
and  trim  it;  first  as  to  the  fullness  we  want  the 
lips  and  cheeks  to  show,  as  you  've  been  shown. 
And  then  trim  as  to  the  show=length  of  the 
teeth,  as  you  've  also  been  shown. 

Then  we  '11  take  the  lower  case  and  trim  it; 
but  this  time  first  as  to  the  show  =  length  of  the 
teeth,  as  you  've  been  shown.  Then,  to  trim 
it  off  even  with  the  upper  rim,  we  '11  take  our 
first  tired=rest  bite,  to  scribe  it  for  that  purpose. 
Then  trim  it  off  to  the  scratch;  and  go  on  and 
finish  it  all  as  a  no=bite,  same  as  you  have  been 
shown. 


188  Greene;  Brothers'  Clinical  Course 

Now,  we  11  fill  our  impressions,  or  bite=plates, 
whichever  we  may  call,  them  (separately) .  And 
when  the  models  are  hard,  we  '11  place  the  no= 
bite,  guided  by  the  jibing  notches  and  knuck- 
les, in  the  articulator.  And  from  this  on  we  11 
finish  the  case  just  as  has  already  been  dem- 
onstrated. 

The  advantages  in  this  newest  invention  are: 
that  we  can  remove  the  handles  from  our  trays, 
to  better  get  the  fullness  of  the  lip  and  cheek, 
in  our  test  impressions;  also  that  there  is  no 
chance  for  slipping  and  changes  in  articulating 
the  bite,  nor  in  transferring  it  from  and  to  the 
models.  Also  bite=plates  can  not  warp  in  a 
metal  tray,  should  they  get  warm. 

Then,  as  we  save  the  taking  of  impressions 
of  the  model  for  bite=plate  purposes,  it  takes 
no  longer,  if  as  long,  with  the  handleless  bite= 
trays. 

In  this  bite=tray  method  we  can  still  use 
the  Greene  ready-made  metal  models,  in  filling 
our  impressions,  the  same  as  before,  if  we  want 
to.  And,  for  certainty  in  restdts,  that  always 
pays. 

Improvement  in  "Biscuit"  Bites.. 

Before  we  invest  our  case,  from  the  artic- 
ulator, I  11  now  fulfill  m}^  promised  improve- 
ment in  "biscuit"  bites,  to  be  used  should  you 
want  to  go  back  to  the  old  habit  for  "old  hab- 
it's' 'sake. 

Take  your  "mush=bite"  in  the  usual  way, 
but  in  modeling  compound,  using  your  wood 
guide=stick  for  (approximate)  width  of  bite. 

Nine  chances  to  one,  you  've  taken  it  (the 
impression),  or  some  part  of  it,  at  too  strong 
pressure.  Now  to  approximately  correct  this, 
just  pour  some  thin,  creamydike  plaster  in  the 
upper  part,   shake  it  mostly  out,  and  take  it 


IN  Dental  Prosthesis.  189 

again,  just  as  before,  but  lightly;    this  to  re- 
lieve excessive  strain,  if  any. 

Now  add  to,  or  take  from,  and  trim  for  the 
feature=test,  with  lips  closed.  Then  take  the  lip= 
line  (laughdine)  and  mark  for  the  showdength 
of  the  teeth,  all  around,  not  forgetting  the  short 
last  molars  above — for  reasons  explained. 

Then  with  a  frame=saw  cut  the  "biscuit" 
in  two  at  this  line;    and  go  on  and  take  the 
tired=rest  bite,  or  no=bite,  with  which  you  are , 
familiar,  the  best  you  can,  under  the  unfavorable 
conditions. 

This  will  by  no  means  give  you  perfection, 
but,  if  the  improvements  have  been  added  right- 
ly, there  will  be  far  less  guess=work  in  your  bite 
and  its  results.- 

Flasking  the  Case. 

You  are  all  familiar  with  the  seemingly  sim- 
ple matter  of  flasking  the  case;  but  there  are 
some  usually  neglected  points  that  I  would  "hol- 
ler" in  the  ears  of  men  and  whisper  in  the  ears 
of  lady  dentists — ^for  best  attention. 

First  of  these  is:  See  that  the  metal  rims 
of  your  flask  come  together  without  rocking 
the  least  bit;  and  see  that  it  's  no  bit  of  old 
plaster  that  prevents  their  rocking;  for,  if  so, 
it  may  disintegrate  and  come  away. 

Second:  See  that  your  models,  if  plaster, 
are  triiTimed  down  to  not  over  a  quarter  of  an 
inch  in  thickness;  and  then,  to  raise  them  up 
to  needed  elevation  in  the  flask,  use  under  them 
some  non= changeable  filling  of  metal  or  its  equiv- 
alent. I  keep  a  few  flat  metal  supports,  vary- 
ing in  thickness  from  one=quarter  to  three= 
quarters  of  an  inch,  and  set  them  with  thin  plas- 
ter on  one  another,  if  more  than  one  is  needed. 

Do  this  even  with  metal  models  where  they 
need  elevating.     For,  though  the  disintegrating 


190  GgiiENB:  Brothe;rs'  Clinical  Course 

and  mashing  of  plaster  under  a  metal  model 
will  not  affect  the  fit  of  the  plate,  it  will  affect 
the  articulation.  Then  we  mis  =  attribute  the 
mal=come=together  as  a  "wrong  bite." 

(By  the  way,  at  some  more  opportune  time 
'  for  visiting,  remind  me  to  tell  you  an  instinct- 
ive story  as  to  where,  when,  and  how  I  got 
the  inspiration  of  the  ready=made  metal  model 
scheme;  and,  incidentally,  how  to  draw  on  the 
great  Universe  of  Intelligence  to  get  thought 
messages  by  order.) 

But  to  our  flasking:  Use  only  good  plaster, 
mix  as  carefully  as  in  making  a  model,  to  avoid 
disintegration;   then  wait  for  perfect  hardening. 

Packing  and  Vulcanizing. 

To  open  the  flask,  warm  it  over  a  small 
spirit  flame,  and  only  enough  to  provide  against 
breaking  the  model.  When  it  is  warmed  through 
from  the  under  side  till  its  top  is  of  good  flesh 
temperature,  it  is  about  right.  Then  the  wax 
inside  isn't  melted  fast  to  the  plaster. 

Open  first  at  the  opposite  point  from  any 
under=cut  in  the  model;  that  is,  usually,  prize 
first  at  the  heel.  When  apart,  quickly  pull  out 
all  the  wax  that  will  come  away.  Then  dip 
in  cold  water  a  minute,  when  you  can  easily 
and  cleanly  flip  off  the  thin  flakes  of  sticky= 
wax,  loosely  adhering  to  the  teeth  and  plaster. 

It  is  better  to  get  it  out  in  this  cold  way 
than  to  steam  it  or  boil  it  out;  as  no  wax 
then  soaks  into  the  plaster,  or  sticks  to  the 
teeth,  to  interfere  with  proper  vulcanization. 
Bear  in  mind  that  it  may  be  even  invisible 
wax,  left  on  the  teeth,  that  causes  softness  and 
difficulty  in  finishing  the  pink  rubber  about 
their  necks. 

?|Use  none  but  the  very  best  vulcanite. 
^Dentists  save  money  at  costly  risk  of  their 


IN  Dental  Prosthesis.  191 

reputation  in  using  poor  materials.  They 
"fake,"  maybe  unwittingly,  on  a  mighty  small 
financial  scale,  in  using  poor  grades  of  rubber — 
in  fact,  poor  grades  of  any  other  material — in 
dental  work. 

Pack  carefully;  use  dry  heat;  squeeze  light- 
ly, and  close  very  slowly.  And,  no  matter  how 
experienced  you  may  be  in  guessing,  you  'd 
better  use  the  trial  cloth,  especially  in  low^er 
cases.  Use  pink  rubber  in  the  center  of  thick 
upper  rims  and  weighted  rubber  in  thick  lower 
ones  to  prevent  porosity,  excepting  in  front. 

The  trial  cloth  is  that  which  comes  between 
sheets  of  rubber.  Don't  wash  the  starch  quite 
all  out.  Then  keep  it  wet,  lest  it  may  stick  to 
the  hot,  soft  vulcanite. 

How  TO  Vulcanize. 

Onl}^  a  few  points  here ;  and  still  ,f ewer  of 
them  new.  But  you  are  a  rare  flock  of  pros- 
thetic birds  if  some  of  you  don't  need  to  have 
some,  even  of  the  old  ones,  re= suggested  to  you. 
"He  that  hath  ears,  let  him  hear" — it  again. 

Then  vulcanize  at  the  lowest  point  possible 
with  your  tried  and  known  thermometer  and 
vulcanizer.  Not  all  thermometers  register  tem- 
perature alike.  Nor,  indeed,  do  all  vulcanizers 
work  alike.  I  have  carefully  changed  the  same 
thermometer  to  different  vulcanizers  and  found 
pronouncedly  different  results. 

Then  test  your  vulcanizer  often  enough  to 
"know  for  yourselves,  and  not  for  another," 
just  how  it  works.  Then,  in  practical  use,  run 
it  at  the  lowest  vulcanizing  temperature  and 
long  enough  to  a  tough=hardness,  and  not  a 
brittle  one. 

Then  leave  it  in  the  flask,  but  not  neces- 
saril}'^  in  the  vulcanizer,  for  several  hours.  Yes, 
for  several  hours  after  it  has  cooled.     Leave  it 


192  Gre;e;ne  Brothers'  Clinicai,  Course 

in  the  flask  over  night  if  3^ou  can.  And  don't 
accept  this  advice  as  a  whimsical  notion  of  an 
old  =  tinier  without  reason.  Each  package  of 
vulcanite  sent  out  to  the  dentists  at  its  first 
introduction  contained  this  advice  and  warning. 

I  '11  not  attempt  to  give  you  the  chemical 
reasons,  but  the  practical  fact  is  that  rubber, 
it  seems,  doesn't  complete  its  crystallic  arrange- 
ment during  the  cooling  process;  and,  if  taken 
out  of  its  imbedment  too  soon,  it  is  liable  to 
waip  by  cramping  on  the  softened  model.  Then 
the  consequences  (which  may  come  even  after 
worn  awhile)  are  often  attributed  to  "change 
of  the  mouth."  Experiments  in  my  own  mouth 
prove  this. 

And  this  is  particularly  true  where  scraping 
and  filing  are  done  to  the  extent  of  bringing 
a  weaker  grain  texture  to  the  surface.  So,  let 
your  pla|:es  "season"  several  hours,  when  you 
can.  Make  quick  plates  only,  in  cases  of  need- 
ful hurry. 

I  wish  I  had  a  Gabriel's  horn  to  toot  to  the 
prosthetic  dental  world  not  to  boil  their  cases 
and  soften  their  plaster  models  before  squeezing 
together;  and  then  not  to  use  much  force,  any- 
how. Ninety  per  cent  of  you  need  this  strong 
talk. 

Dishonesty  in  Rubber  Plates. 

I  know  mainly  three  reasons  for  brittle 
rubber  plates:  (a)  absolute  Dishonesty;  {h) 
Carelessness,  which  is  a  reckless  child  of  Dis- 
honesty; and  if)  Ignorance,  which  is  a  legit- 
imate offspring  of  Carelessness. 

When  a  vulcanite  plate  breaks,  especially 
if  in  the  mouth,  the  dentist  ought  to  be  re- 
sponsible for  it.  For  it  is  next  to  impossible 
to  break  a  properly  made  plate  of  really  good 
stuff;    and  it  is  a  dentist's  duty  to  test  his  ma- 


IN  Dental  Prosthesis.  193 

terial  before  promiscuously  using  ancl'sellmg  it. 

It  would  pay  you  all,  and  at  the  same  time 
be  a  good  "educator  of  the  people,"  to  make 
and  keep  several  toothless  plates  to  jump  up= 
and=down  on,  and  to  throw  against  the  wall,  to 
show  your  patients  what  you  can  do;  and  then 
do  it  honestly.  I  insist  that  a  properly  made 
and  properly  fitted  vulcanite  plate,  of  good  ma- 
terial, will  not  break  in  the  mouth;  nor  will  it 
out  of  the  mouth  without  considerable  effort. 
The  "cow=hom"  samples  sent  out  by  the  man- 
ufacturers are  proof  of  that. 

There  are  numerous  coverings  for  plaster 
models,  to  prevent  the  usual  deterioration  of 
rubber  in  vulcanizing  contact  with  gypsum- 
There  are  some  excellent  liquid  "glosses."  Af- 
ter strongly  advising  those  of  you  who  don't 
use  anything,  to  use  something,  I  will  state  that 
I  still  use  thin  tin=foil,  preferably  number  four. 
And  even  thin  gold  foil  is  not  too  expensive 
for  the  benefit,  if  no  tin  is  at  hand.  The  claim 
that  thin  foil,  placed  evenly  all  over  a  model, 
will  change  the  fit  of  a  plate,  on  flesh  tissue, 
is  high=grade  theory,  backed  by  low=grade  fact. 

The  model  is  at  first  painted  with  thin  var- 
nish, and  the  foil  then  hurriedly  smoothed  on 
with  a  common  shaving=brush.  Then  the  foil 
is  as  hurriedly  smoothed  over  with  pulverized 
soapstone  on  the  brush.  (We  licked  the  foil 
on  before  the  days  of  dangerous  microbes.) 

If  for  no  other  one  of  several  good  reasons, 
I  w^ould  thus  cover  my  plaster  models  to  bring 
them  out  of  the  flask  clean  and  save  time  in 
not  otherwise  even  half=way  cleaning  them  of 
tightly  adhering  plaster. 

Plaster  can  be  very  quickly  scrubbed  off  the 
foil,  and  the  foil  as  cjuickly  eaten  off  the  plas- 
ter, by  a  thin,  hasty  amalgam,  made  in  the 
hand,  of  tin=foil,  or  tobacco=foil,  and  mercury. 


194  Greene  Brothers'  Clinicae  Course 

The  fact  is,  a  rubber  plate  should  come  out 
of  the  flask  clean,  fairly  smooth,  and  almost 
finished.  It  should  need  no  trimming,  other 
than  of  small  excess  extensions;  no  filing,  nor 
scraping,  as  to  its  shaping. 

Last  Finishing  Care  in  Articulation. 

Ten  to  twenty  minutes  will  finish  our  double 
set  of  teeth,  after  out  of  the  flask,  if  we  have 
modern  lathe  machinery.  We  '11  slip  them  into 
patient's  mouth  to  see  whether  or  not  they 
come  together  properly. 

Nor  will  we  jump  to  any  hasty  conclusion 
about  it;  for  we  have  all  been  fooled  in  that 
way.  We  have  quickly  concluded  articulations 
were  all  right,  when  a  few  hours,  or  days,  proved 
otherwise.  And  sometimes  we  have  hastily  said 
to  ourselves,  if  not  to  our  patients:  "They  are 
all  wrong;  you  hit  wrongly,  and  I  '11  have  to 
make  them  over;"  when  a  little  time  showed 
a  mistake,  in  our  favor.   , 

Now,  to  forestall  the  like  of  this,  we  '11  take 
a  regular  no=bite  on  the  finished  denture  to  see 
for  sure  about  it.  If  it  proves,  all  is  well.  If 
the  teeth  don't  hit  rightly,  it  is  nine=to=one  on 
account  of  some  change  after  in  the  flask,  dur- 
ing vulcanization. 

But  it  can't  be  much  wrong;  nothing  that 
can't  be  corrected.  So,  if  needs  be,  we  '11  cor- 
rect it.     And  here  is  the  way  we  '11  do  it. 

We  '11  trace  a  little  very  thin  smidgen  of 
plaster  on  top  of  the  lower  teeth  and  take  an- 
other no=bite  on  it.  When  the  plaster  is  hard, 
we  '11  take  the  teeth  out  of  the  mouth,  and, 
using  compound  or  wax  instead  of  plaster,  we  '11 
fasten  them  in  the  articulator;  the  plaster  on 
the  teeth  being  our  articulating  guide. 

1  In  placing  them  in  the  articulator,  we  '11  be 
just  as  careful  in  the  use  of  the  face = bow,  or 


IN  Djjntai,  Prosthesis.  195 

measurmg=stick,  as'we^were  in"  articulating  the 
bite  in  the  first  place,  and  for  the  same  ex- 
plained reasons. 

When  these  finished  dentures  are  in  the  ar- 
ticulator, we  '11  remove  the  plaster  from  be- 
tween them,  bring  them  together,  and  look  rm- 
der  and  see  what  has  to  be  grormd  off. 

A  few  touches  with  the  carborundum  wheel, 
and  the  worst  is  off.  Now  we  '11  follow  up 
with  carborundum  sand=paper,  by  sliding  it  be- 
tween the  teeth  imtil  each  one  will" touch  its 
opponent,  even  to  the  holding  of  the  thinnest 
tissue  paper,  if  we  so  wish. 

But  in  this  final  grinding  we  mustn't  neg- 
lect to  give  the  lateral  motion  to  the  articu- 
lator, to  wear, the  teeth  off  to  the  regulation 
lateral  quid= chewing  attrition. 

A  Still  Finer  Last  Grinding  Touch. 

A  still  finer  last  touch  may  be  made,  with 
carborundum  grit.  Stick  a  strong  piano=wire 
coil=spring  firmly  onto  the  extending  point  of 
the  guide  screw  of  the  articulator,  of  a  length 
to  push  the  teeth  to  about  an  inch  apart.  ^  -     ^ 

Then  put  a  "bump=wheel"  on  your  lathe 
spindle  and  hold  the  articulator  so  the  bumps 
will  strike  it  on  top.  The  spring  will  open  the 
jaws,  and  the  bump  (one  or  more)  on  the  wheel 
will  close  them.  Thus  you  '11  have  a  chewing= 
machine  to  make  hundreds  or  thousands  [  of 
bites  a  minute. 

This  wheel  may  be  of  felt,  soft  wood,  doub- 
led sole=leather,  or  soft  rubber;  and  should  be 
from  four  to  five  inches  in  diameter. 

All  you  need  to  do,  to  add  this  last  exquis- 
ite touch,  is  to  feed  a  mixture  of  carborundum 
grit  and  gl3^cerine,  with  a  small  brush,  while 
you  wabble  the  jaws  for  the  quid  =  motion — and 
whistle  "  Yankee=Doodle=Dixie"   ten  or  fifteen 


196  Greene  Brothers'  Clinical  Course 

minutes.  Some  dentist,  without  reflecting  what 
nerve  mixture  the  average  man  or  woman  is 
made  of,  has  notoriously  suggested  that  this 
grit  =  grinding  process  should  be  done  in  the 
mouth ! ! ! 

Better  Defer  Final  Adjustment. 

But,  doctors,  it  is  best  in  cases  of  unequal 
tissues  and  soft  m.ouths  to  let  artificial  dentures 
be  worn  a  few  hours,  or  in  bad  cases  days,  for 
adjustment,  before  those  final  touches  in  oc- 
clusion are  given.  It  's  best,  really,  to  let  all 
artificial  dentures  "settle"  well  before  the  final 
occlusive  grinding— if  they  need  grinding. 

Instructions  to  Wearer  of 
Artificial  Teeth. 

' '  Now,  Madam,  you  have  a  set  of  teeth  that 
stand  the  best  regulation  test.  The  upper  ones 
stay  in  your  mouth  with  usual  movements  of 
face  and  deglutitory  muscles. 

"The  lower  ones  stay  in  place  with  these 
ordinary  movements,  and  you  can  hold  them 
in  their  extraordinary  motion. 

"The  dentist  has  done  his  part  faithfully  to 
the  finish.  Will  you  do  yours  the  same?  If 
so,  all  will  be  well,  and  you  '11  have  comfort 
and  benefit  that  can't  be  measured  by  money. 

' '  But  it  may  require  some  auto=suggestive 
determination,  perseverance,  and  practice  to 
reach  the  goal. 

"First:  Use  3'our  own  favorable  auto=sug- 
gestion,  and  reject  the  adverse  suggestions  of 
others.  This  is  the  first  and  generally  the  worst 
thing  wearers  of  nev/  teeth  have  to  meet  with 
and  to  overcome. 

"Some  may  tell  you  your  teeth  are  too 
short,  and  others  tell  you  too  long.  Some  may 
say  they  fill  your  mouth  out  too  much,   and 


IN  Dental  Prosthesis.  197 

others  say  not  enough.  Many  wiU  insist  that 
your  teeth  are  too  dark,  and  some  few  say  too 
white;  and  so  on. 

"Without  their  pre  =  auto  =  suggestion ,  few 
women,  or  men,  under  similar  circumstances, 
wouldn't  be  disconcerted  as  to  their  hats  or 
coats. 

"And  hardly  one  woman  in  ore  hurdred 
who  could  not  be  discom-posed,  and  nin  in  off 
the  street,  if  strangers  were  to  look  at  her,  and 
several  of  her  frier ds  should  tell  her  that  her 
skirt  was  ridiculously  short;  even  in  face  of 
the  truth  that  it  w-as  too  long.  Indeed,  any 
discussion  atout  the  matter  would  disconcert 
her.     Of  course,  you  are  an  exception. 

"Now,  Madam,  3^our  teeth  are  right  in  size, 
style,  and  color  to  suit  your  features;  your  oivn 
features. 

"I  have  made  them  to  look  like  your  per- 
fect natural  teeth  w^ould  look  at  your  peaceful 
status  of  earthly  incarnation,  sometimes  vulgarly 
stated  as  your  age.  Beware  especially  of  what 
your  inartistic  friends  may  say  as  to  their  shade. 

"If  they  were  lighter  in  color,  the  contrast 
would  make  you  appear  ridiculous,  and,  in  fact, 
the  older.  They  give  you  the  appearance  of 
a  preserved  lady  of  your  sweet  sixty.  So^  ac- 
cept no  suggestion  to  the  contrary! 

"And,  now,  for  learning  the  art  of  chewing 
on  them.  This  comes  much  more  naturally  to 
some  people  than  to  others.  But  all  have  it  to 
learn;   and  most  of  them  by  progressive  degrees. 

' '  You  '11  first  have  to  learn  to  chew  on  both 
sides  of  your  mouth  at  the  same  time.  This  is 
to  cause  your  gums  to  settle  and  adjust  them- 
selves to  both  sides  alike.  Otherwise  the  plates 
would  settle  the  more  unevenh^  as  the  usual 
adjustment  took  place. 

"You  will  easiest  and  quickest  leam  on  thin 


198  Greene  Brothers'  Clinical  Course 

slices  of  boiled  ham  or  tender  dried  beef.  Put 
a  piece  on  either  side  to  place  and  chew,  and 
chew,  and  chew,  and  swallow  and  chew.        ;;,.^ 

"Go  on  and  'Fletcherize'  till  nieal=time,  and 
then  take  the  plates  out  of  the  mouth.  But, 
when  the  meal  is  over,  go  at  it  again  and  chew 
sliced  meat  or  its  equivalent  as  before,  on  both 
sides  at  once,  until  meal=time  again;  and  so 
forth. 

' '  Keep  this  up  persistently  till  you  can  chew 
a  little  better  with  the  teeth  than  without  them. 
This  will  not  be  many  days.  Then,  when  you 
feel  their  need  and  benefit,  leave  them  in  dur- 
ing meals.  But  then,  at  first,  use  only  small 
bits,  if  of  promiscuous  food. 

"  In  a  week  or  ten  days,  you  11  begin  to  use 
them  pretty  well;  and  in  a  month,  or  less, 
perfectly. 

"Heed  this  advice,  and  you  '11  have  no 
trouble;  ignore  it,  and  your  road  to  success 
may  be  longer,  if  not  beset  with  difficulties, 
both  imaginary  and  real. 

"And  now,  further,  Madam,  to  forestall  all 
ill  suggestion,  auto  or  otherwise,  I  '11  here  and 
now  clinch  and  settle  the  matter  of  mastica- 
tion. I  have  here  some  of  the  thin  slices  of 
ham  and  beef  I  've  advised,  and  will  give  you 
a  practical  start  that  will  be  unquestioned  and 
satisfactory.  [Here  she  is  made  to  chew  on 
both  sides  at  a  time  until  she  is  satisfied.] 

"Now,  Mrs.  Jones,  you  have  chewed  several 
minutes  without  trouble.  Next  time  it  will  be 
easier;  and  the  next  time  still  easier;  and  so 
on  until  you  '11  forget  that  your  teeth  are  shop= 
made,  at  all. 

' '  Your  teeth,  at  first  seemingly  naughty  and 
worrying,  will  in  time  behave  admirably  from 
■your  persistent,  but  serene,  will=power. 

' '  Your  eyes  will  renew  their  suasive  dancing. 


IN  Dental  Prosthesis.  199 

Your  cheeks  and  features  will  regain  their  full- 
ness and  flush  of  the  sweet  ago — as  much  as 
the  Goddess  of  Duration  thinks  best  for  you. 

"And  even  your  inartistic  friends  will  ad- 
just themselves  to  your  regenerated  looks  and 
feelings  of  sweetness. 

"But  finally,  Madam,  I  beg  and  implore 
you  not  to  accept  this  extra  fine,  artistic  set 
of  teeth  merely  on  financial  account.  In  such 
a  case,  money  is  vulgar.  I  've  taken  all  these 
pains  for  your  happiness  and  my  own  glory.'' 

No=BiTE  OF  A  Plain  Upper  Case.    . 

Being  through  with  a  plain  full  "double" 
set,  we  '11  now  take  up  this  single,  simple,  up- 
per, toothless  jaw,  articulating  with  a  toothful 
lower  one.  If,  however,  a  few  lower  teeth  were 
lacking,  the  bite  would  be  similar. 

We  managed  a  similar  case  one  way,  and 
a  good  way,  in  our  "advertiser's  quick=step." 
(Index  A.)  And  another  in  the  Greene  quick= 
step.  (Index  G.)  Now  we  '11  have  two  more 
ways;  the  first  one  being  my  own  once  "regu- 
lar" way. 

I  have  it  here  on  this  same  old=fashioned 
articulator  with  anatomical  attachments.  But 
the  same  principles  and  points  will  apply  on 
any  other  articulator. 

Take  your  model,  on  which  you  intend  to 
vulcanize  your  plate,  and  soapstone  it  to  pre- 
vent the  impression  material  from  sticking  to 
it.  Then  take  an  impression  of  it,  without  a 
tray.  Work  the  impression  down  thin- in  the 
roof,  and  build  it  out  full  enough  and  down 
long  enough  to  allow  for  trimming,  both  as  to 
the  fullness  of  lips  and  the  showdength  of  the 
teeth.  It  is  always  easier  to  trim  oft"  than  to 
add  to;  even  by  our  new  wa}^  of  tracing=on 
modeling  compound  from  tracing=sticks. 


200  Greene  Brothers'  Clinicai,  Course 

The  projecting  shoulder  on  the  model  will 
be  your  guide  as  to  the  thickness  of  the  bite= 
plate's  rim  at  the  top.  Next  trim  for  the  ap- 
proximate fullness  of  the  outer  lip  lower  down. 
But  exactness  here  isn't  really  of  much  im- 
portance, since  the  upper  teeth  have  to  come 
together  within  certain  relations  to  the  natural 
lower  ones,  anyhow. 

Then  next  comes  the  show=length  of  the 
teeth,  where  no  g  u  e  s  s  =  work  is  permissible. 
Mark  the  lip=line,  harmonizing  with  the  laugh= 
line,  and  trim  the  bite=plate  down  to  it.  Cut 
in  front  only,  and  for  the  width=space  of,  say, 
the  four  incisors;  and,  if  needs  be,  including 
cuspids.  Then  have  patient  repeat  vigorous 
smiling  until  you  're  sure  of  the  proper  show= 
length  of  the  coming  teeth. 

If  you  can't  see  well,  you  can  paste  a  strip 
of  white  paper  onto  the  bite=rim,  down  to  where 
you  have  trimmed  it,  to  show  how  long  the  teeth 
would  show;  or  you  could  even  stick  some  in- 
cisors onto  the  compound,  if  you  wanted  to. 

Next:  Cool  the  trimmed  portion  in  front 
and  warm  the  top  of  all  the  rest  of  it,  rearvrard. 
Then  have  her  bite  onto  this  softened  top  until 
the  trimmed,  hard  front  strikes  the  lower  teeth 
and  stops  the  jaw.  If  this  should  require  more 
than  once  warming,  repeat  it,  of  course. 

When  you  have  had  patient  mash  oif  the 
bite=rim  for  the  show=length  of  the  teeth,  and 
have  removed  the  side=mashed  surplus,  you  are 
ready  to  tire  her  jaw  and  register  its  natural 
position;  that  is,  to  take  the  no=bite,  which  is 
some  different  from  the  full  set,  in  this: 

Instead  of  testing  it  by  notches  and  knuck- 
les, as  we  did  in  the  full  case,  you  '11  do  it  in 
this  way:  Roughen  the  bite=rim  in  front,  back, 
say,  to  the  place  of  the  first  bicuspid,  so  that 
warm  compound  will  stick  to  it.     You  '11  have 


IN  DENTAL  Prosttiksis.  201 

a  little  roll,  or  thin  slab,  of  this  in  hot  water 
ready  for  use.  And  now  for  the  non=lateral, 
perpendicular,  minimum  short  bite.  Is  it  nec- 
essary to  show  that  again?  (Class:  "  Yes;  go 
on  and  give  it  again.") 

The  Non'Lateral,  Minimum  Short=Bite, 
OR  "No=BiTE,"  Described  Again. 

"Now,  Madam,  suck  this  bite=plate  up  tight- 
ly; then  let  your  jaws  approach  very  slowly 
till  your  lips  touch  together  lightly  and  the 
lower  teeth  almost  touch  the  rim. 

"There,  there,  Madam!  hold  just  that  way 
while  I  count  ten;  then  snap  and  hold  fast. 
One,  two,  three,  four,  five,  six,  seven,  eight, 
nine,  ten — snap  and  hold!'' 

The  jaw  was  at  tired^rest,  and  the  remain- 
ing space  too  narrow  to  admit  of  unintentional, 
lateral  side=motion. 

While  she  bites  down,  I  take  my  strip  of 
ready  warmed  compound  and  press  it  fimily 
against  the  roughened  bite=rim  (above)  and  also 
against  the  natural  teeth  below. 

The  rough  surface  on  the  bite = rim  will  hold 
it  till  I  get  done;  and  the  saliva  on  the  lower 
teeth  will  prevent  its  sticking  thereto. 

I  will  now  take  it  out  of  the  mouth  and, 
with  a  small,  hot  knife=blade,  stick  this  con- 
necting strip,  at  both  of  its  ends,  more  tightly 
to  the  roughened  rim,  lest  it  might  come  loose. 

The  two  together,  the  strip  and  the  bite= 
rim,  look  like  a  single  piece  into  which  she 
has  bitten.  But  the  biting  was  done  (at  short 
range,  avoiding  lateral  motion)  before  the  con- 
necting strip  was  pressed  on. 

Next  we  '11  warm  our  knife=blade  again  and 
shorten  the  connecting  strip  off  down  almost 
even  with  the  edge  of  the  bite  =  rim  proper. 
We   '11  leave  just  enough  to  show  a  little  of 


202  Gre;e:ne  Brothers'  Clinical  Course 

the  sockets  of  the  lower  teeth,  into  which  these 
teeth  are  to  enter  when  we  make  our  no=bite 
test,  later  on. 

Well,  the  connecting  strip  has  now  been 
shaved  off,  and  on  purpose  that  we  can  see 
the  ends  of  the  lower  teeth  enter  the  shallow 
sockets;  or  else  jail  to  enter,  if  the  no=bite 
should  be  wrong,  when  we  make  the  test. 

So  we  are  now  ready  to  test  our  no=bite. 

The  Full  Upper  No=Bite  Test. 

"Again,  Madam,  give  me  a  test=bite  on  this. 
Close  slowly  just  as  before;  only  this  time  keep 
your  lips  apart  so  I  can  see  your  teeth  enter 
their  little  sockets  as  3^ou  close. 

"Close  slowly,  slowly!  There,  now,  your 
teeth  almost  touch  the  rimi.  Hold  till  I  count 
ten:  One,  two,  three,  four,  five,  six,  seven,  eight, 
nine,  ten!" 

I  looked  up  under  her  lip  and  saw  the  ends 
of  her  lower  teeth  smoothly  slide  into  their  shal- 
low sockets  on  the  edge  of  the  upper  bite=rim. 

"Now,  Madam,  that  's  correct.  Let  me  try 
it  again." 

We  test  again;  and  the  fact  that  the  jaw 
was  at  rest  is  confirmed  by  thi'ee  or  more  tire= 
test  witnesses. 

If  the  teeth  had  -missed  or  failed  to  go  into 
their  sockets  smoothly,  a  few  trials  would  have 
shown  at  which  one  of  the  three  times  the  jaw 
had  moved  sideways.  In  such  a  case,  the  no= 
bite  would  simply  have  to  be  re=taken  until  the 
case  would  prove.  But  the  proof  would  be  un- 
questionable. 

But  we  are  here  granting  a  very  remote 
probability;  for,  if  this  operation  is  rightly 
done,  it  will  not  fail  once  in  fifty  times.  Of 
course,  this  "rightly"  includes  receptive  in- 
structi(Dns  and,  sometimes,  some  training  of 
patients. 


IN  Dental  Prosthesis.  203 

And  here  let  us  lament  that  dentists  gen- 
erally know  so  little  about  methodical  sugges- 
tion to  their  patients.  {A  fourth  lecture  \will 
be  added  to  this  Course  on  "Scientific  Sug- 
gestion IN  Dental  Practice,"  before  long.) 

Transfer  the  No=Bite  to  Articulator. 

Now  let  us  transfer  our  test=bite  onto  the 
articulator.  We  '11  use  a  model  of  the  natural 
lower  teeth;  preferably  a  metal  one.  f|Such  can 
be  made  of  low=f using  metal,  in  a  modeling= 
compound  impression,  as  readily  as  of  plaster. 
And  the  advantage  is  that  the  teeth  on  it  won't 
wear  by  friction  like  on  a  plaster  one. 

The  shallow  sockets,  aforesaid,  in  our  upper 
bite=rim  will  be  our  guide  in  placing  the  bite 
onto  the  lower  model. 

If  we  have  no  face=bow,  or  don't  know  how 
to  use  one,  or  can't  find  the  exact  condyle 
movement,  we  '11  substitute  our  always  avail- 
able three=and=a=halfsinch  measurement  =  stick. 

We  '11  then  first  place  the  lower  model  cor- 
rectly straight  in  the  articulator  on  the  table 
with  the  ends  of  the  teeth  at  least  approxi- 
mately three  and  a  half  inches  from^  the  cross= 
bar,  and  fasten  it  there.  Then  press  the  bite 
to  place  onto  this  lower  model  carefully;  then 
the  upper  model  into  this,  its  bite=plate.  Then 
bear  down  firmly  on  the  model,  without  press- 
ure on  the  metal  jaw,  while  w^e  plaster  it  all 
together. 

We  '11  next  change  off  our  bite=plate  for  a 
base=plate,  onto  which  the  teeth  will  set. 

This  base=plate,  as  shown  in  the  double=set 
case,  can  be  of  wax  and  dipped=on,  unless  we 
care  to  take  it  off  to  try  it  in  the  mouth  as  to 
looks.  Or  it  ma}^  be  of  common  base=plate  ma- 
terial, like  the  Ken'  "Perfection,"  and  pressed 
onto  the  model.     But,  in  any  case,  if  the  model 


204  Greene  Brothers'  ClinicaIv  Course 

is  flat,  it  is  best  to  secure  the  base=plate  to  it 
by  a  previous  thin  dipping,  or  heating,  to  pre- 
vent sHpping. 

Next  we  11  set  the  teeth  personally  (pref- 
erably), and  not  by  ignorant,  careless  proxy, 
to  the  lower  model;  always  with  an  eye  on 
the  set=screw.  We  '11  first  give  them  a  square 
"one=way"  come=together,  and  then  follow  up 
with  the  chewing  movements  of  the  lower  jaw. 

And  here  is  the  advantage  of  metal  models 
of  the  lower  teeth  over  plaster  ones:  the  metal 
ones  won't  wear  off  by  the  adjusting,  frictional, 
chewing  process. 

From  this  on,  the  work  is  the  same  as  shown 
in  the  upper  one  of  our  double  set. 

Pink  Rubber  and  Gum  Sections. 

To  be  honest  with  my  patient,  I  would  use 
pink  rubber,  if  at  all,  no  higher  up  than  the 
laugh=test  indicates. 

When  I  want  to  make  an  extra  nice  set  of 
teeth  on  vulcanite,  I  use  gum  sections  of  pat- 
tern  and  shade  to  harmonize  with  my  patient's 
normal  face  and  her  age. 

I  think  harmony  may  be  of  even  first  im- 
portance, over  the  fit  of  artificial  teeth.  For 
a  plate  worn  in  a  hand=bag  won't  do  both,  dis- 
grace the  dentist  and  disfigure  his  patient. 

I  well  remember  when  it  was  unethical  and 
disgraceful  to  make  a  permanent  denture  of 
"plain  teeth."  In  fact,  gumless  teeth  have 
made  rubber  work  so  easy,  in  a  manner,  as 
to  bring  it  into  disrepute. 

[  3  Bites  in  Scattering  Cases. 

On  my  rounds  among  dentists  I  find  quite 
a  good  mxany  still  taking  base=plate  rim=bites  in 
partial  cases  of  scattering  teeth.  In  such  a 
case,  the  best  and  only  bite  needed  is  to  make 


IN  Dental  Prosthesis.  205 

models  of  the  natural  teeth,  tipper  and  lower, 
and  place  these  together  properl}^  on  the  artic- 
ulator, and  exactly  as  those  touched  in  the 
mouth.  Abrasion  of  the  natural  teeth,  copied 
onto  the  models,  will  nearly  always  show  how 
to  match  the  models  in  the  articulator  without 
any  other  bite.  But,  in  exceptional  instances, 
thin  sheets  of  bite=marked  wax  will  help  in  the 
adjustment.  Indeed,  in  many  cases,  it  's  not 
necessary  to  even  put  them  in  the  articulator. 

Pressometer  in  Upper  Cases. 

In  single  upper  cases,  it  is  seldom  necessary 
to  use  the  pressometer;  only  w^hen  decided  dif- 
ference in  texture  at  different  places  is  evident. 
You  have  been  shown  its  practical  use  under 
such  circumstances. 

But,  in  any  case,  the  teeth  on  the  wax  base= 
plate  should  touch  their  opponents  a  little  bit 
first  over  the  soft  parts,  to  make  up  for  un- 
equal settling.  The  exception  is  where  hard 
parts  support  adjacent  soft  ones. 

From  this  on  to  the  finish  of  our  single  up- 
per case,  we  '11  closely  follow  the  demonstra- 
tion, directions,  and  precautions  given  in  the 
upper  one  of  the  double  set.  We  11  sacredly 
heed  the  points  of  special  importance  in  ma- 
terial, fiasking,  packing,  vulcanizing,  and  the 
countersign:  Keep  an  eye  on  the  seUscrew,  and 
dont  spring  the  articulator. 

Partial  Posterior  Lower  Bite. 

Here  is  a  case  of  a  partial  lower  set,  where, 
for  instance,  the  molars,  and  maybe  bicuspids, 
are  lacking;  but  the  front  teeth  are  intact.  It 
is  a  case  wherein  even  truthful  dentists  will 
sometimes — prevaricate,  a  little.  At  least,  I 
think  so  when  they  tell  me  they  seldom  have 
to  grind  the  teeth  off  after  vulcanizing. 


206  Greenk  Brothers'  Clinical  Course 

Onh^  those  who  carefully  observe  and  get 
the';  proper  strain  in  taking  their  bite,  or  in  try- 
ing^ the  teeth  in,  can  truthfully  avoid  making 
the,  common  error  of  getting  the  jaw  teeth  too 
long — if  the  tissues  tmder  the  plate  are  soft. 

And  it  comes  about  in  this  way:  They  take 
the'- bite  too  hard;  that  is,  the  material; is  too 
hard,  or  the  pressure  on  the  soft  tissues  too 
strong — maybe  both.  The  principle  is  illustrat- 
ed in  the  use  of  our  pressometer.     (Index  P.) 

A  short  way  of  stating  the  fact  is  this :  The 
patient  bit  more  into  the  flesh  than  into  the  ma- 
terial. In  the  biting,  the  natural  teeth  didn't 
give  down  at  all.  If  the  soft  tissues  under  the 
bite  =  plate  gave  any,  then  the  finished  teeth, 
when  set  up  to  the  bite,  will,  of  course,  come 
together  just  as  much  too  soon  as  w^as  the  dif- 
ference in  the  yielding. 

Also,  at  the  natural  wearing  stress  of  a  dent- 
ure, of  course  such  gums  yield  some.  Now, 
whatever  anioimt  they  are  forced  to  give  more 
than  this,  by  undue  strain  in  taking  the  bite, 
represents  the  amount  the  teeth  will  have  to 
be  shortened. 

And  since  most  dentists  (nearly  all)  take 
such  impressions,  abnormally  straining  for  such 
tissues,  just  so  many  have  to  after=grind;  or 
else  compel  their  patients  to  go  through  an  un- 
necessary, long  season  of  annoying  and  painful 
adjustment. 

And,  of  course,  just  the  same  results  follow 
undue  pressure  in  trying  the  teeth,  set  up  on 
the  base=plate,  in  the  mouth.  "Just  wear  'em 
till  you  get  used  to  'em." 

But  it  is  reversely  trtie  that,  in  such  cases 
of  soft  tissues,  insujf.cient  strain  on  the  bite 
gives  lack  of  proper  up= touch  of  the  teeth.  So 
it  sometimes  happens  that,  in  cases  of  too  light 
pressure  in  the  bite,  the  artificial  teeth  are  cor- 
respondingly too  short. 


IN  Dental  Prosthesis.  207 

While  we  can  get  the  presstire  almost  ex- 
actl}^  right,  with  little  trouble,  by  the  use  of 
the  pressometer  test=slips  in  clear  mouths,  we 
can  get  it  practically  so  without  them  in  par- 
tial cases  by  ni}'  recent  compensating  discovery. 

And  this  is  the  way  I  do  it:  I  first  make 
my  bite=plate,  preferably  of  gutta=percha  base= 
plate  material,  to  fit  snugly  onto  nty  model. 
Then  stiffen  it  with  annealed  brass  wire.  The 
soft  wire  is  first  bent  to  the  bare  model  and 
then  warmed  and  pressed  into  the  now=placed 
gutta=percha. 

Though  this  wire  is  pliable,  it  is  stiff  enough 
to  make  the  base  =  plate  rigid,  so  it  can  be 
removed,  off  and  on,  in  the  preparation  and 
operation. 

On  this  gutta=percha  base  I  place  modeling 
compound  to  reach  up  to  the  opposing  teeth, 
natural  or  artificial,  above,  and  to  press  them 
a  little;  then  trim  off  the  sides  of  this  bite=rim 
to  rid  of  surplus. 

Then  for  the  bite.  The  compound,  alone,  is 
warmed  and  the  jaws  closed  on  it  till  the  front 
teeth  come  properly  together.  Their  coming= 
together  is  our  guide=stop. 

Now,  if  the  bite=rim  is  softer  than  the  flesh 
under  it,  the  pressure  will  not  be  too  strong. 
But  the  chances  are  five=to=one  that  the  mate- 
rial will  be  too  hard  at  the  actual  biting  instant. 

As  I  rather  expect  this,  I  forestall  it  with 
a  ver}^  thin,  soft  plaster  addition  on  top  of  the 
compound,  after  first  shaving  off  a  little  of  the 
latter,  to  make  room  for  the  plaster.  The  slow 
setting  of  the  creamy  plaster  gives  ample  time 
for  the  operation.  And  the  softness  of  it  al- 
wa3^s  provides  against  overstrain. 

But  in  very  soft  cases,  where  the  gums  are 
sure  to  settle  a  good  deal  from  pressure  by 
wearing  a  plate,  provision  must  be  made  for 


208  Greene  Broti-iers'  Clinical  Course 

the  change.  That  is,  the  artificial  teeth,  when 
finished,  should  touch  their  opponents  a  littie 
before  the  front  natural  ones  touch  theirs;  the 
amount  of  the  extra  strain  being  according  to 
the  softness  of  the  tissues. 

I  arrange  for  this  fore=touching  of  the  arti- 
ficial teeth  by  placing  a  sheet,  or  several  sheets, 
of  tin=foil  on  the  ends  of  the  front  lower  nat- 
ural teeth,  closely  adapted,  while  the  bite  is 
taken  and  when  the  artificial  teeth  are  being 
set  up. 

The  thickness  of  this  provisionary  foil=strip 
depends  on  the  yieldance  of  the  gums  to  be 
bitten  on.  It  gives  to  the  rear  artificial  teeth 
an  extra  length  just  a  small  per  cent  less  than 
the  thickness  of  the  foil.  The  grain  of  guess= 
work  about  the  foil  provision  is  made  admissi- 
■  ble  by  the  accommodating  adaptability  of  soft 
tissue.  Anyhow,  it  is  practicable  enough  to 
bridge  over  a  deep  chasm  of  trouble.  (This 
simple,  new  solution  of  a  vexing  old  problem 
is  carefully  shown  in  our  verbal  Course.) 

N.  B. — I'  should  have  stated  timely  that  I  re- 
move at  least  a  part  of  the  modeling=compoimd= 
and=plaster=bite  from  the  gutta=percha,  or  oth- 
er base  foundation,  after  the  case  is  in  the  artic- 
ulator; and  then  put  enough  sticky=wax  on  to 
set  the  teeth  into.  The  gutta=percha  base=plate 
itself  isn't  removed  until  the  flask  is  opened 
for  packing. 

It  may  not  be  amiss  here  to  re=mention  that 
in  these  partial  cases  the  lateral  movement  of 
the  jaw  should  be  attended  to,  either  on  the 
bite=rim  in  the  mouth  or  on  the  articulator. 
The  latter  is  preferred  when  the  bite  on  the 
modeling  compound  is  finished  out  with  the 
cream=like  plaster.  Sometimes  both  are  advisa- 
ble. In  fact,  such  cases  indicate  our  scheme: 
Each  mouth  its  own  articulator  in  the  finish. 


IN  DijNTAL  Prosthesis.  209 

You  are  all  familiar  with  the  use  of  the  car- 
bon and  wax  strip  in  after=grinding  for  occlu- 
sion. Well,  I  've  given  3^ou  a  much  preferable 
way,  by  which  all  such  grinding  is  done  lui- 
known  to  the  patient,  and  with  utmost  accur- 
acy; that  is,  by  taking  a  short = bite,  re= artic- 
ulating the  finished  plates,  and  doing  all  grind- 
ing in  the  laboratory,  out  of  sight. 

But,  if  only  a  little  touching=up  is  needed, 
you  can  indicate  with  the  Kerr  tracing=sticks. 
Dry  the  teeth,  trace = on  a  thin  layer,  warm  it 
well,  and  have  patient  bite  into  it.  Then  re- 
move the  particular  thin  flake  where  it  is  bit- 
ten through,  and  grind  with  small  carborun- 
dum bulb.  Then  trace=on  more  and  repeat, 
biting  and  grinding,  till  you  get  a  close = touching 
occlusion  everywhere. 


210  Grrknk  Brothers'  Clinical  Coursic 


INDEX. 


PAGE 

Musclc-Trimmiug,  or  Very-Edging 40 

Very-Edging,  or  Muscle-Trimming 40 

Length  of  Upper  Plate 35j  36,  37 

Post-Damming  Rear  of  Plate 46 

Practitioner's  Method  of  Fitting  Tray  to  Mouth. 26,  27,  28 

Conforming 43,  44,  45 

"Pass- Word"  Method  of  Plaster  Impression 75,  76 

Test  for  Pass-Word  Impression 76 

Fit  Tray  to  Upper  Mouth 26,  27,  28 

Fit  Tray  to  Lower  Mouth 95,  96 

Lower  Trays  Illustrated — Old  Style  and   Improved, 

Figures  10,  11,  12 97 

Correctable  Lower  Modeling-Compound  Impression — 

Student's  Method 98 

To  Separate  Impression  from  Approximate  Model. ...    98 

Coring  Out  Under-Cuts  in  Lower  Impressions 99 

Practitioner's  Correctable  Lower  Impression 100 

Remove  Teeth  from  Old  Plate 88 

Cloth  in  Packing 83 

Refitting  Plates  with  Vulcanite 83 

Mercurial-Tin  Paste  for  Removing  Tin-Foil  from  Vul- 
canite Plates 90 

A  Quick-Step  Denture 78 

Greene's  Quick-Step  Denture. . 00 

Tracing-on  Modeling  Compound  with  Kerr  Tracing- 
Sticks  26 


THE  GREENE 

READY-MADE,  NON-CHANGEABLE 

APPROXIMATE  MODELS 

For  Vulcanite  and  Celluloid  Work,  and  Swaging. 

Invented  by  Dr.  J.  W.  Greene. 
Patented  June  23,  1908. 


Doctor:  Doesn't  it  frequently,  if  not  often,  happen  that  with 
even  a  "good  impression  you  have  a  badly  fitting  "denture"? 

Do  you  know  how  this  mostly  happens?  You'll  probably 
answer:  "My  impression  changed  before  I  poured  my  model,  or, 
maybe,  my  model  changed  before  I  used  it." 

These  things  may  have  occurred,  but  nine  chances  to  one  they 
did  not.  Your  trouble  far  more  probably  came  from  change  that 
took  place  in  your  plaster  model  in  flasking  and  vulcanizing;  or  in 
squeezing,  if  a  celluloid  case. 

Why,  even  the  very  best  of  plaster  models  are  liable  to  change 
shape  under  heat,  moisture,  and  pressure.  And  faulty  ones  are 
sure  to  do  it. 

In  fact,  most  plaster  disintegrates  at  about  300°  F.  So  you 
nearly  always  vulcanize  on  a  soft-surfaced  model,  and  often  on  one 
really  mushy  throughout. 

In  such  cases  you  depend  on  environment  to  hold  your  mush 
in  shape.    But  if  your  pressure  in  flasking  is  heavy,  or  undue  in 


any  direction,  your  soft  plaster  model  will  yield,  and  your  plate 
will  differ  in  shape  from  your  impression  of  the  mouth. 

Have  you  ever  realized  this?  Have  you  ever  seriously  thought 
of  the  changeability  of  plaster,  especially  in  vulcanizing,  and  in 
molding  celluloid  plates? 

The  remedy  is 

THE    GREENE    READY-MADE    NON-CHANGEABLE    MODEL 
SYSTEM. 

With  these,  no  matter,  then,  how  ignorant  or  careless  you  or 
your  assistants  may  be  in  making  and  using  faulty  plaster  casts, 
you  will  make  no  more  misfits  from  distorted  models. 

//  your  impression  is  really  correct,  then  your  plate  will  be  just 
as  correct.  Of  cource,  provided  you  don't  cool  your  plate  too  quick- 
ly, nor  take  the  case  out  of  the  fiask  too  soon,  and  thereby  cause 
it  to  warp. 

These  models  are  made  of  cast  Aluminum,  loo  different  shapes 
in  a  set— 87  uppers  and  13  lowers. 

The  uppers  are  of  seven  different  sizes,  numbered  from  14  to 
20,  these  sizes  grading  one-eighth  of  an  inch  in  difference  in  width. 
Then  in  each  size  there  is  an  average  of  a  dozen  different  shapes  to 
conform  to  as  many  different  styles  of  mouths  and  gums — as  deep, 
shallow,  thick,  thin,  broad,  narrow,  etc.     These  shapes  are  lettered. 

With  these  100  full  patterns  any  normal  case  can  be  accom- 
modated. 

The  models  cannot  break,  bend,  wear  out,  nor  get  out  of  order; 
but  may  be  used  over  and  again  indefinitely. 

The  full  set  is  put  up  in  a  neat  case,  with  a  special  compart- 
ment for  each  shape,  numbered  and  lettered. 

HOW  TO  SELECT,   FIT  AND  USE  THEM. 

Take  your  impression  as  usual;  or  better,  by  the  Greene  method, 
using  Perfection  Impression  Material  (which  gives  you  the  exact 
height  of  rim  and  length  of  intended  plate,  and  an  absolute  advance 
test  as  to  its  fitting).  Now  measure  across  the  back  of  your  impres- 
sion, from  outside  to  outside  of  tuberosities,  to  get  its  size  and  num- 
ber.   For  instance:  two  inches  wide  would  be  the  width  of  No.  16. 

Select  from  model  No.  15,  which  is  one-eighth  of  an  inch  nar- 
rower than  No.  16,  the  nearest  the  shape  of  the  impression. 

This  selected  model  should  slip  loosely  down  into  the  impres- 
sion. If  it  lacks  a  little  of  going  in,  use  Carbon  paper  to  indicate 
and  find  the  places,  and  file  or  scrape  the  model  off  to  let  it  in 
with,  say,  an  eighth  of  an  inch  play;  less  will  do. 

After  your  model  will  drop  into  the  impression  readily,  it  is 
fitted.  Then  mix  your  plaster  (good  plaster),  smear  your  model 
all  over  its  face-surface  carefully;  then  pour  a  little  plaster  into 
the  impression,  fullest  in  the  center,  and  push  the  besmeared  model 
down  into  it,  and  go  on  and  finish  as  if  model  were  all  plaster. 

You  now  have  a  model  about  90  per  cent  metal,  in  bulk,  with 
ID  per  cent  or  less  of  plaster  veneering  over  its  face.  The  metal 
will  not  change  at  all,  while  the  ver)''  thin  coating  of  plaster  facing 
(being  supported  by  metal)  cannot  change  perceptibly. 

Nor  does  it  take  much  longer  to  make  this  non-changeable 
cast  than  the  old,  faulty,  all-plaster  sort.  Go  on  and  use  it  the 
same  as  if  all  plaster,  in  vulcanite  or  celluloid  work. 

In  using  these  approximate  models  for  partial  cases,  first  fill 


the  tooth  sockets  in  the  impression.  If  in  removing  the  impres- 
sion from  the  model  you  should  break  off  a  tooth,  just  ceirient  it 
back  to  its  place  with  thin  cement,  which  makes  it  stronger  than 
before  broken. 

TO  SEPARATE  IMPRESSION   FROM   MODEL. 

Remove  the  impression  from  the  model,  rather  than  model 
from  impresson.  First  remove  the  metal  tray  from  impressisn,  by 
warming  the  metal  over  spirit  flame.  If  impression  is  modeling 
compound  (Perfection  Impression  Material),  or  wax,  first  warm 
the  im,pression  gently  in  shallow  water,  leaving  the  model  as  cool 
as  possible,  and  peel  the  former  off  from  the  latter. 

FOR   SWAGING. 

These  ready-made  models  are  convenient  and  practical  in 
swaging,  when  the  new  process  methods  of  pressure  are  used.  And 
especially  so  where  wax  or  modeling  composition  is  used  for  im- 
pression. It  requires  just  the  right  kind  of  low-fusing  metal  and 
care  to  make  a  swage  model  in  a  modeling  compound  impression. 
But  these  approximates  are  easily  fitted  to  such  impressions  and 
likewise  to  beeswax-  impressions. 

To  complete  them  for  swaging,  use  a  half-and-half  mixture  of 
Portland  cement  and  plaster,  well  ground  together  in  a  mortar,  be- 
fore wetting. 

And  to  swage  on  them,  first  "cow-horn"  your  blank  plate  over 
a  metal  model  of  the  next  size  larger  than  the  one  you  are  going  to 
finally  swage  to. 

If  you  use  the  Greene  method  of  taking  impressions,  you  can 
swage-  turn  the  very  utmost  rim  edge  of  your  plate,  to  fit  the  muscles 
to  such  exactness  as  to  need  no  trimming  after  plate  is  worn,  unless 
the  mouth  changes. 


Price,  Full  Set  of  100  Models,  $20.00. 


Manufactured  by 

DETROIT  DENTAL  MFG.  CO 

DETROIT,  MICH.,  U.  S.  A. 


KERR  PERFECTION  IMPRESSION  COMPOUND. 


Softens  Easily—  Hardens  Quickly. 

This  Compound  softens  at  a  very  low  tem- 
perature. 

It  hardens  very  quickly  in  the  mouth,  be- 
coming very  hard,  and  does  not  warp. 

When  pressed  to  place  in  the  mouth,  it  will 
not  creep,  but  stays  where  put. 

(Dr.  J.  W.  Greene  has  used  this  material  ex- 
clusively in  all  his  clinic  impression-work.) 

Manufactured  by  the 

Detroit  Dental  Manufacturing  Company, 

Detroit,  Mich.,  U.  S.  A. 


Kerr  Perfection  Impression  Compound  Sticks 


QtWiiU,  \«,\^.U-5.. 


are  very  convenient   where   a  small    quantity  is  to  be 
added ;  especially  where  to  be  accurately  traced-on. 

(Suggested  by  Dr.  J.  W.  Greene.) 
Manufactured  by  the 

Detroit  Dental  Manufacturing  Company, 

Detroit,  Mich.,  U.  S.  A. 
Kerr  Perfection  Impression  Compound  Wafers 


are  most  convenient  for  spreading  over  a  surface  to  add 
slightly  to  its  thickness. 

It  softens  instantly  over  dry  heat,  and  hardens  quickly. 

(Suggested  by  Dr.  J.  W.  Greene,  for  various  uses.) 

Manufactured  by  the 

Detroit  Dental  Manufacturing  Company, 

Detroit,  Mich.,  U.  S.  A. 


Greene's 
Impression-and-Bite  Trays, 

With  Detachable  Handles. 

(Invented  by  Dr.  J.  W.  Greene,  Chillicothe,  Mo.^ — 1910,) 


Patent  and  Manufacture  Controlled  Solely  by  the 

Detroit  Dental  Manufacturing  Company, 

Detroit,  Mich.,  U.  S.  A. 

V 


For  special  instructions,  take  Dr.  Greene's 
Course  in  "New  Test  Methods  in  Plate=Work," 
or  see  his  Printed  Lectures — just  out. 


Greene  brof^^e^s  ri'iir,-.!  ro--^5  :r  rjent 


2002386399 


